Atypical Myocardial Infarction Research Articles

TCT-768 Female Gender and the Prevalence of Atypical Myocardial Infarction in a Diverse Urban Population

TCT-768 Female Gender and the Prevalence of Atypical Myocardial Infarction in a Diverse Urban Population

Clinical features of acute coronary syndrome in elderly patients with chronic obstructive pulmonary disease

Aim. To study the clinical features of the course of acute coronary syndrome (ACS) in elderly patients with chronic obstructive pulmonary disease (COPD).Materials and methods. The study included 78 patients with ACS: 43 patients with ACS and COPD (group 1) and 35 patients with ACS without COPD (group 2). All patients underwent comprehensive clinical, instrumental, and laboratory examinations.Results. Among the risk factors for cardiovascular diseases (CVD), the most significant contributors to the development of ACS in patients with COPD were smoking, arterial hypertension, and elevated levels of C-reactive protein (CRP). Patients with ACS and COPD more frequently had non- ST-segment elevation myocardial infarction (NSTEMI). For patients with comorbid pathology, more pronounced changes in the coronary arteries were characteristic due to an increase in the total number of stenoses (p=0.02), hemodynamically significant stenosis (p=0.01), occlusions and critical stenoses (p=0.02), and extensive stenoses (p=0.04). Group 1 patients, compared to group 2, had hemodynamically significant stenosis located in the proximal (p=0.04) and distal (p=0.02) segments of the coronary arteries, as well as in second-order branches (p=0.02). No significant differences were found between the groups in the number of stenoses of the left main coronary artery and the middle segments of the major coronary arteries.Conclusion. In elderly patients with COPD, ACS development was more often preceded by angina symptoms and atypical myocardial infarction presentations, with NSTEMI predominating in the myocardial infarction structure. The main CVD risk factors in COPD patients were smoking, arterial hypertension, and elevated CRP levels. Atherosclerotic coronary artery disease in ACS patients with COPD was characterized by multivessel disease, predominance of middle and distal coronary artery stenosis. A significant feature of coronary artery disease in comorbid elderly patients was the increased total number of stenoses and the number of extensive stenoses.

Atypical Presentations of Myocardial Infarction: A Systematic Review of Case Reports.

There is a rising incidence of coronary artery diseases and myocardial infarction (MI). Mortality associated with acute MI (AMI) is directly linked to the time to receive treatment and missed diagnoses. Although health professionals are aware of typical AMI presentation, atypical MI is difficult to diagnose, which on the other hand, is likely to have an impact on morbidity and mortality. Therefore, it is prudent to know such atypical presentations, especially for emergency and primary care physicians. We aimed to systematically evaluate the clinical presentations of atypical MI and analyze them to characterize the common clinical presentations of atypical MI. We researched the PubMed database, did citation tracking, and performed Google Scholar advanced search to find the cases reported on the atypical presentation of MI published from January 2000 to September 2022. Articles of all languages were included; Google Translate was used to translate articles published in languages other than English. A total of 496 (56 PubMed articles, 340 citations from included PubMed articles, and 100 articles from Google Scholar advanced search) were screened; 52 case reports were evaluated, and their data were analyzed. Atypical presentations of myocardial infarction are vast; patients may have chest pain without typical characteristics of angina pain or may not have chest pain. No typical characterization could be done. Most patients were in their fifth decade or above of their life and commonly presented with pain and discomfort in the abdomen, head, and neck regions. Prodromal symptoms were consistent findings, and many patients had two to three comorbidities out of four common comorbidities, i.e., diabetes, hypertension, dyslipidemia, and substance abuse.A patient who is 50 years old or more, having comorbidities such as diabetes, hypertension, dyslipidemia, history of tobacco or marijuana usage, presenting with prodromal symptoms like shortness of breath, dizziness, fatigue, syncope, gastrointestinal discomfort or head/neck pain should be suspected for atypical MI.

Livestreamed cross-institutional hybrid simulations on healthcare inequality: a time, cost and environmentally friendly opportunity for large group learning?

Students intercalating in BSc Urgent and Emergency Care/BSc Critical Care degrees undertake placements in 32 NHS Trusts across the UK. A collaborative simulation day was planned between the University and a geographically distant hospital, aiming to explore bias within healthcare. Inequality has been examined through simulation previously and recommendations exist on maximising simulation effectiveness [1]. A hybrid simulation day took place with 11 students present ‘in-situ’ and 49 remote students across the UK joining a livestream. High-definition cameras provided multi-angle simulation views plus a patient monitor with separate audio from ceiling-mounted boundary microphones. A webcam and cardioid microphone captured the debriefing. The free programme OBS Studio controlled the livestream as a single ‘virtual camera’, with test results overlaid as appropriate. Scenarios involved an atypical myocardial infarction, sickle cell crisis, and female genital mutilation/trauma in pregnancy. Feedback from learners (n=21) rated the content most useful for ‘trauma in pregnancy’ (2.95/5) and ‘teamworking’ (2.90/5), whilst ‘networking with peers’ was lowest rated (2.21/5). Scenarios were realistic (75%) and appropriate for training level (86%). However, the audio-visual system was rated adequate by only 57%. Comments described difficulty with simultaneous speech during the simulation. Satisfaction with reflective debriefing was 76%, however free-text comments revealed verbal feedback delivered to simulation teams by ‘remote’ peers was perceived more critically than feedback received from local faculty. A novel technological setup with OBS Studio was used for a collaborative simulation event viewed across the UK. Scenarios were rated positively. There was difficulty discerning multiple audio streams during the simulation. We plan to provide team leaders with dedicated microphones for overall commentary. We recognised the lack of diversity in simulation manikins within the host hospital and, as recommended [1], are now arranging representative manikins that can be used routinely and not for stereotypical scenarios. Feedback from a remote group to a smaller ‘in-situ’ participant group can feel daunting and direct. This may reflect the challenging topics explored, but also difficulties recognising the nuances of nonverbal cues in a virtual space. As such, care must be taken with ground rules, and facilitating appropriate exploration of learning points. Although feedback has identified areas for improvement, hybrid simulation can deliver immersive experiences to geographically-dispersed learners which are time- and cost-effective, with reduced environmental impact from travel. Alongside allowing physical-distancing, it may support distance-learning and facilitate cross-institutional collaborations. We recommend exploring OBS Studio for livestreaming simulations [2]. 1. Vora S, Dahlen B, Adler M, Kessler DO, Jones VF, Kimble S, Calhoun A. Recommendations and Guidelines for the Use of Simulation to Address Structural Racism and Implicit Bias. Simulation in Healthcare. 2021;16(4):275–294. 2. Gumble E. Setting up for remote simulation using OBS Studio. 2021.

Cardiac Complications of Hypertensive Emergency: Classification, Diagnosis and Management Challenges.

While mortality in patients with hypertensive emergency has significantly improved over the past decades, the incidence and complications associated with acute hypertension-mediated organ damage have not followed a similar trend. Hypertensive emergency is characterized by an abrupt surge in blood pressure, mostly occurring in people with pre-existing hypertension to result in acute hypertension-mediated organ damage. Acute hypertension-mediated organ damage commonly affects the cardiovascular system, and present as acute heart failure, myocardial infarction, and less commonly, acute aortic syndrome. Elevated cardiac troponin with or without myocardial infarction is one of the major determinants of outcome in hypertensive emergency. Despite being an established entity distinct from myocardial infarction, myocardial injury has not been systematically studied in hypertensive emergency. The current guidelines on the evaluation and management of hypertensive emergencies limit the cardiac troponin assay to patients presenting with features of myocardial ischemia and acute coronary syndrome, resulting in underdiagnosis, especially of atypical myocardial infarction. In this narrative review, we aimed to give an overview of the epidemiology and pathophysiology of hypertensive emergencies, highlight challenges in the evaluation, classification, and treatment of hypertensive emergency, and propose an algorithm for the evaluation and classification of cardiac acute hypertension-mediated organ damage.

Clinical and anamnestic features and the nature of medical care for patients of older age groups as factors of unfavorable prognosis of myocardial infarction

Objective: to study the features of the anamnestic background, clinical course, as well as the nature of medical care for elderly patients with acute myocardial infarction (MI) and to assess their impact on the prognosis of the disease. Material and methods: the study included patients 60 years and older who survived acute MI and registered in the «Register of Acute Myocardial Infarction»(Tomsk) (n=410). The study conducted a 5-year prospective follow-up of patients with an assessment of their vital status. The Statistica V10.0 application software package («StatSoft Inc.») was used for statistical processing of the data obtained. Results: the analysis showed that 90% of patients had a history of comorbid pathology. In almost 20% of patients, the onset of the disease was characterized by an atypical clinical picture, which in more than a third of cases was represented by a low-symptomatic form. The presence of atypical MI manifestation lengthened the prehospital stage of medical care due to the late treatment of patients for medical help (120 [49; 311.5] minutes), as well as longer time before the first medical contact (26.5 [20;40] minutes (p=0.005)). A fifth of patients were treated for acute MI in non-core hospitals, where the hospital mortality rate among elderly patients reached 65.7%, which was 3 times higher than the same indicator in specialized cardiology departments (19.7%, p<0.001). Conclusion: the main factors affecting the long-term postinfarction period in elderly patients were: isolated systolic arterial hypertension, diabetes mellitus, impaired renal function, a history of myocardial infarction and acute cerebrovascular accident.

The effectiveness of resuscitation in patients with acute myocardial infarction according to the population register

Aim To study clinical and anamnestic features and tactics of managing patients with acute myocardial infarction (MI) in groups with different effectiveness of resuscitation procedures.Materials and methods Patients were selected using the "Acute Myocardial Infarction Registry" epidemiological program. 219 cases of acute MI recorded from 2007 through 2017, which required emergency life support, were studied. Two groups were formed based on success of the resuscitation: group 1 consisted of patients with acute MI who survived due to the cardiovascular life support (n=61); group 2 included fatal cases after resuscitation failure (n=158). Quantitative variables were described as median and interquartile range, Ме (Q1; Q3); comparison was performed in two independent samples using the Mann-Whitney test. Qualitative variables were presented as absolute and relative values (n (%)). Statistical significance of differences in nominal properties was determined with contingency tables (Pearson χ2; two-tailed Fisher's exact test). Critical level of two-tailed significance was set equal to 0.05.Results The groups consisted of severe cases at baseline. The groups were sex- and age-matched. Mean age of patients in groups 1 and 2 was 63.5±13.1 and 60.9±14.8 years, respectively (р=0.2); in both groups, females were considerably older than males. Analysis of preceding drug therapy showed that comparable proportions of patients received antihypertensive and/or anti-ischemic treatment; however, the qualitative composition of the therapies was significantly different in these group. Thus, survived patients more frequently than deceased patients received drugs from vitally important groups, including β-blockers (93 % and 13 %, р<0.001), antiplatelets (97 % and 13 %, р<0.001), statins (84 % and 5 %, р<0.001), and angiotensin-converting enzyme (ACE) inhibitors (90 % and 8 %, р<0.001). In additions. success of resuscitation procedures was interrelated with the clinical picture. Thus, in atypical MI, the rate of fatal outcomes was higher (89 % and 56.5 %, р<0.001) despite the life support.Conclusion The patients who survived due to resuscitation procedures more frequently had a history of adequate drug therapy for ischemic heart disease and arterial hypertension with β-blockers, ACE inhibitors, antiplatelets, and statins. In this group, MI mostly had a clinical picture of a prolonged anginal attack. The long-term prediction for survivors after successful resuscitation presently remains important and requires further study.

Factors affecting awareness of myocardial infarction symptoms among the general public in Korea.

OBJECTIVESWe aimed to determine the level of awareness of myocardial infarction (MI) symptoms among the general public in Korea and identify factors affecting awareness of MI symptoms using data from the 2017 Korea Community Health Survey (KCHS).METHODSThis is a cross-sectional study using KCHS data. Based on five questions about MI symptoms, participants were divided into an awareness group (replied ‘yes’ to all five questions) and an unawareness group (replied ‘no’ or ‘not sure’ to at least one of five questions) for analysis.RESULTSOf a total of 228,281 participants, 42.4% were aware of MI symptoms. There was a high level of awareness of chest pain and shortness of breath, but a low level of awareness of gastrointestinal symptoms and pain in the arm, shoulder, jaw, neck, and back. While women had a higher level of overall awareness relative to men, they showed a lower level of awareness regarding chest pain and discomfort. The factors affecting awareness of MI symptoms were gender, age, education level, occupation, smoking, drinking, physical inactivity, and cardiovascular disease risk factors. CONCLUSIONSIn order to enhance awareness of MI symptoms among the general population, appropriate education and promotion efforts must be implemented based on gender, age, education level, and occupation. Moreover, active efforts by the government, educational institutions, and medical institutions are necessary to improve awareness of both typical and atypical MI symptoms. Furthermore, health policies to promote reduced smoking and drinking and increased physical activity, as well as continuous monitoring and management of individuals with cardiovascular disease risk factors, are required.

ATYPICAL CLINICAL COURSE OF THE ACUTE MYOCARDIAL INFARCTION: CLINICAL AND ANAMNESTIC CHARACTERISTIC OF PATIENTS, MANAGEMENT AND OUTCOMES (DATA FROM REGISTRY OF ACUTE MYOCARDIAL INFARCTION)

Aim. To study clinical and anamnestic specifics, management and outcomes of acute myocardial infarction (MI) in patients with atypical clinical presentation. Material and methods. Among the Tomsk population, those having had acute MI in 2009-2014 y. were included, registered in the database “Registry of Acute MI” (n=5602), and selected to groups with atypical (n=1319) and common (n=4283) clinical presentation of the MI onset. Statistics was done with software “Statistica 10”. Results. Atypical presentation of MI took place in 23,5% cases. These patients were much older than those with common angina at MI onset; they had more prevalent arterial hypertension, obesity, diabetes. Also, the prevalence of anamnestic MI did not differ between groups, however autopsy revealed more common painless MI. Atypical MI presentation patients sought for medical care in 28 days before the event of MI more frequently than those with typical clinical picture: 36% vs. 26% (p<0,001), but electrocardiography was ordered only for a half of them (54%), that led to misdiagnostics of pre-infarction condition. Every second patient with atypical MI was hospitalized to non-specialized unit, where could not receive high-technology treatment, which hence led to worse outcomes and prognosis. Conclusion. It is necessary to be careful with non-typical MI development possibility in older patients with several comorbidities, and with anamnesis of painless acute MI. Chance of fatal outcome in atypical MI is 10 times higher in this group than in those with typical clinical presentation.

Acute Coronary Syndromes in Women: Recent Treatment Trends and Outcomes.

In the USA and internationally, women experience farranging differences with respect to acute coronary syndrome (ACS) and myocardial infarction (MI). Women suffer from more comorbidities than men, such as smoking, obesity, hypertension, diabetes, and poor mental health. They some-times exhibit atypical MI presentation symptoms and are overall less likely to present with chest pain. Women are more likely than men to encounter delays between the onset of symptoms and arrival at the hospital or to guideline treatment. The use of various surgical and pharmacological treatments, including revascularization approaches, also differs. Women, on average, have worse outcomes than men following MI, with more complications, higher mortality rates, and poorer recovery. Internationally, outcomes are similar despite various differences in health care and culture in non-US countries. In this review, we detail differences regarding ACS and MI in women, describing their complex correlations and discussing their possible causes. Educational approaches that are tailored to women might help to reduce the incidence of ACS and MI, as well as outcomes following hospitalization. Although outcomes following acute MI have been improving over the years, women may require special consideration in order to see continued improvement.

对不典型心肌梗死误诊的临床分析

Objective :to analyse the reason of misdiagnosis of atypical myocardial infarction. Methods : To analyze 12 cases by combining with typical cases. Results :12 cases were misdiagnosed as stomach problem,bronchial asthma,micturition syncope,cor pulmonale right heart failure,diabetic coma,acute cholecystitis,intercostals neuralgia,arrhythmia,etc. Conclusion : The misdiagnosis is mainly due to the clinician’s less experience, insufficient attention to patients, stop-gap measures, narrow mind of clinical diagnosis, lack of understanding of atypical myocardial infarction, subjective diagnoses, lack of understanding myocardial infarction in the elderly, variability,lack of routine dynamic monitoring examination of electrocardiogram and serum myocardial enzyme.

Telemetry-assisted early detection of STEMI in patients with atypical symptoms by paramedic performed 12-lead EKG analysis

Background: The purpose our study was to determine whether patients presenting with atypical myocardial infarction symptoms displayed ST-segment elevation in a 12-lead EKG written by prehospital first responders.

A review of the types of presentation among positive angiographic acute coronary syndrome patients in Hospital Universiti Sains Malaysia

Atypical presentation of myocardial infarction is recognized as an important manifestation of coronary heart disease associated with unfavorable prognosis. Understanding the spectrum of clinical symptoms and presentations are essential to diagnose and deliver appropriate rapid treatment to patients in the emergency department. Hence, this study was carried out to identify the type of presentation of acute coronary syndrome (ACS) and its association with the risk factors related to the atypical presentation in population of study. Out of 260 patients, 25.8% had atypical presentation of ACS with the presentation of right sided chest pain (1.8%), burning chest pain (20.9%) and pricking chest pain (15%). The significant associated diseases were diabetes mellitus and past medical history of ischaemic heart disease (p<0.01) respectively. Other significant associated symptoms were epigastric pain (p<0.001), cough (p<0.01) and giddiness (p<0.01). As a conclusion, ACS with atypical presentations remains an important presentation in the Emergency Department. Despite the availability of advanced medical technology, a thorough history taking remains an important component of diagnosis for a better management and outcome of ACS. Key words: Atypical myocardial infarction, common presentation, emergency department.

Clinical analysis of 26 patients with atypical myocardial infarction

Objective To analyze the clinical characteristics of atypical acute myocardial infarction,improve the diagnosis of myocardial infarction. Methods To analyze the main clinical characteristics of the patients with atypical acute myocardial infarction in our hospital in the past 3 years ,which compared to the typical acute myocardial infarction. Results Atypical acute myocardial infarction includes atypical symptom and atypical ECG, atypical symptoms is more prevail. Compared with typical acute myocardial infarction, the women, elderly people and hypertension patients is more common, fewer anterior myocardial infarction and poorer prognosis ( P ＜ 0.05 ). Conclusion To improve the understanding of atypical acute myocardial infarction,was benefit of reducing the misdiagnosis and mistreatment of acute myocardial infarction. Key words: Myocardial infarction

Awareness of Heart Attack Symptoms and Lifesaving Actions Among New York City Area Residents

The American Heart Association has a national network of community-based programs designed to reduce response times to cardiac emergencies by improving access to automatic external defibrillators (AEDs) among laypersons. Success of these Operation Heartbeat programs depends in part on the public's knowledge of the warning signs of a myocardial infarction (MI) and appropriate response to cardiac arrest victims. In May 2000, a 7-minute telephone survey was administered to a random sample of adults residing within the American Heart Association affiliate territories of New York, New Jersey, and Connecticut to determine the knowledge of MI symptoms, confidence in cardiopulmonary resuscitation (CPR) use, and the awareness of AEDs. Of the respondents, 60% were women (n=1,128), 83% were Caucasians (n=1,558), 15.2% were non-whites (African American, Asian, or Hispanic), and 38.5% had at least a college degree (n=724). Women were significantly more likely than men to know that sex differences exist in the warning signs for an MI (63% vs. 30.7%, respectively; P< .001). Whites had above-average confidence in MI recognition compared with non-whites (39.2% vs. 27.4%, respectively; P< .001) and were more cognizant of the public availability of AEDs (54.5% vs. 33.2%, respectively; P< .001). Our findings suggest that racial/ethnic and sex disparities exist in the awareness of AEDs and in the knowledge of atypical MI symptoms in women, respectively. Innovative CPR outreach programs might be needed in New York area communities to increase CPR training among all adults, to increase AED awareness in vulnerable populations, and to improve knowledge and confidence in the recognition of acute MI symptoms.

Prevalence, clinical features, and acute course of atypical myocardial infarction.

Ninety-four consecutive patients (60 men and 34 women; mean age 68.5 +/- 11.5 years) with acute myocardial infarction (MI) were investigated retrospectively, in order to evaluate the prevalence, clinical features, and short-term course of the atypical forms (symptoms other than chest pain). An atypical MI was found in 30 patients, with a prevalence of 32% (95% confidence limits 27-36%). It was most prevalent in women above sixty-five years old (P < 0.05). Abdominal pain, paroxysmal dyspnea, and pulmonary edema were the most frequent symptoms (33%, 17%, 13%, respectively). No differences were observed between typical and atypical MI in regard to risk factors (hypercholesterolemia, arterial hypertension, diabetes mellitus, cigarette smoking) and history of MI, cerebrovascular disease, peripheral vascular disease, or chronic lung disease. Significantly fewer patients with atypical MI had a history of angina pectoris (P < 0.05). No differences were observed in regard to previous medication, except for antiarrhythmic drugs, more often used by atypical patients (P < 0.05). Location and severity of MI (as judged by ECG and peak levels of creatine kinase in the serum) were similar in both subgroups, as were the complications (34% typical and 50% atypical) and death rate (12.5% and 16.7%, respectively). In conclusion, atypical MI is not less severe than typical. This emphasizes the need for a high suspicion index in many different clinical settings, but particularly (although not exclusively) in elderly females, in the presence of abdominal pain or otherwise unexplained paroxysmal dyspnea.

心筋硬そくの発症に関する研究 非典型的心筋硬そく発症への胆のう異常の関与

We have already reported, not only, several cases with myocardial infarction which were caused by some kinds of disturbance in gall bladder (G.B.), but also, some ones with arrythmias and/or angina pectoris; of course, they have been suffering from coronary sclerosis.In this paper, the authors want to represent high incidence of complication with myocardial infarction (MI) and G.B. disturbance and the possibility which G.B. disfunction would contribute the patients with ishemic heart diseases progress to MI.Fourty seven cases in sixty three with MI, 74.9% of the patients, including six cases of autopsies, showed abnormalities on oral cholecystographic examination. Thirteen cases (20.3%) had gall stones, and the other cases showed abnormalities of morphology and/or disfunction of G.B. contraction. As for gall stone, statistical difference revealed high frequency appearance in female than in male, but concerning comparison with the position of MI, and/or age, no difference were showed.High incidence of contraction abnormalities revealed in the cases with atypical MI. than typical MI. which were classified by clinical and laboratory findings, though no difference of serum cholesterol and triglycerides levels between the patients with abnormal oral cholecystography and normal ones. This investigation revealed the possibility which G.B. disturbance would contribute the patients with ishemic heart diseases developed to atypical MI, but it is seldom to be seen the possibility which disturbance of G.B. should be a factor of coronary sclerosis.

Prevalence and Clinical Course in Atypical Myocardial Infarction

Prevalence and Clinical Course in Atypical Myocardial Infarction

心脳卒中の病理学的研究 (II)

Cardiocerebral apoplexy is difined as atypical myocardial infarction the onset of which is symptom of cerebrovascular disease which characterized by frequent occurence in older age and malacic lesion of brain, as discribed by Fujii. But, its detailed pathological process remains to be a matter of much controversy. It is therefore necessary to perform further studies of cardiac lesions of cerebrovascular diseases as well as cerebral lesions of myocardial infarction for elucidating the pathology of cardiocerebal apoplexy. Now, we examined cardiac lesions of 35 autopsy cases of cerebral infarction. A study of coronary lesions and myocardial fibrosis has been attempted. 11 cases were associated with myocrdial infarction and 4 cases of them were regarded as cases of typical cardiocerebral apoplexy. Moreover, in many cases over 60 years old involving cases of myocardial infarction we observed marked myocardial fibrosis which strongly indicated the presence of coronary insufficiency. Marked myocardial fibrosis and myocardial infarction were apperrently prominent in cases of cerebral hemorrhage and subarachnoid hemorrhage as discribed by Katoh. If we classify cerebral infarction to massive cortical encephalomalacia, multiple encephalomalacia and few encephalomalacia, myocardial infarction and marked myocardial fibrosis are usually outstanding in the 2nd group.Based on these observations, it may be presumable that the hitheto described cardiocerebral apoplaxy is a pattern of extreme severity and various cases of slight to moderate clinical coursed should be existed.

The Cases of Atypical Myocardial Infarction

The Cases of Atypical Myocardial Infarction