Myriad Cardiac Manifestation of Hyperhomocysteinemia

Homocysteine has been recognized as a risk factor for various cardiovascular manifestations including thrombosis of arterial and venous system, spontaneous dissection involving various vessels in the body including coronaries and aneurysms. Here we report a young gentleman who was diagnosed as stroke in young and found to have dilated cardiomyopathy, with left ventricular dysfunction and hyperhomocysteinemia. Now the patient was presenting with unstable angina and found to have layered left ventricular thrombus on echocardiography and spontaneous coronary artery dissection on angiography. Our patient is being followed up on optimal medical management, as he is asymptomatic with medications.