A 73-year-old man who had both high BP and high cholesterol suffered an inferior-wall MI. ECG findings showed non-Q-wave, non-ST-segment elevation. Stents were implanted in his right and left coronary arteries. On a regimen of simvastatin, enalapril, metoprolol, clopidogrel, and aspirin, his lipids have normalized, as has his BP. Beginning in his teen years, the patient has experienced scintillating scotomas without cephalalgia or other symptoms. Frequency varied from once in several weeks to many per day, always lasting 25 minutes. Since his MI and the subsequent treatment, he has had no scotomas. Why?
—Neil Cohen, MD, Jamaica Estates, N.Y.
The mechanism for this unexpected benefit is unclear. Scotomas are usually attributed to vasoconstriction, but if there is an element of increased platelet aggregation and/or endothelial inflammation, clopidogrel, aspirin, or both may be responsible (Ann Intern Med. 2007;146:34-44).
—Peter F. Cohn, MD (121-4)