Onset Of Chest Pain Research Articles

LncRNA HIF1A-AS2: a potential biomarker for early diagnosis of acute myocardial infarction and predictor of left ventricular dysfunction

BackgroundRapid diagnosis of acute myocardial infarction (AMI) is the subject of many clinical studies as it enables an effective therapy, preventing adverse progression of AMI and increasing survival rates. Recent studies have revealed that specific blood-based long non-coding RNAs (lncRNAs) are deregulated in patients with AMI and serve as promising diagnostic and prognostic tools. The current study aimed to determine the potential role of a hypoxia-responsive lncRNA, hypoxia-inducible factor 1A antisense RNA 2 (HIF1A-AS2), as a biomarker for early diagnosis and predictor of left ventricular dysfunction (LVD).MethodsThis study was carried out on 48 patients with AMI and 50 age-and sex-matched controls. The relative quantification of HIF1A-AS2 expression was done using reverse transcription real‐time polymerase chain reaction.ResultsCompared to the control group, HIF1A-AS2 were significantly higher in MI patients (P < 0.001). Interestingly, patients presenting within 3 h of chest pain onset had elevated levels of HIF1A‐AS2 as compared to patients with late presentation. The ROC curve was constructed to assess HIF1A-AS2 as an early marker. It demonstrated higher sensitivity (94%) and specificity (86%). Moreover, the multivariate regression analysis revealed that HIF1A‐AS2 was significantly associated with LVD in the patient group after 6 months follow up (p = 0.018).ConclusionOur study suggests that HIF1A‐AS2 may be a potential early diagnostic biomarker of AMI with high sensitivity. In addition, it might have a promising role as a predictor of left ventricular dysfunction.

Hand-Schüller-Christian syndrome combined with empty sella syndrome: A case report and literature review.

Hand-Schüller-Christian syndrome (HCS) is a rare disease with little clinical awareness, but the condition is more dangerous, and it combines with empty sella syndrome (ESS) which is extremely rare. A 26-year-old male patient who had proptosis, headaches, and diabetes insipidus for more than 10 years, and chronic cough and wheeze for 8 years presented to our hospital due to an abrupt onset of chest pain for 2 days. Hand-Schüller-Christian syndrome is diagnosed based on the typical clinical manifestations of diabetes insipidus and bilateral proptosis, magnetic resonance imaging (MRI) pituitary imaging and pathology. Empty sella syndrome is diagnosed based on hormonal indicators, clinical manifestations and MRI pituitary scan results. Type 1 respiratory failure and severe pneumonia can be diagnosed based on the results of clinical examination, chest imaging (including chest x-ray and computed tomography), pathology and blood gas analysis. Left pneumothorax can be diagnosed with chest imaging. "Meropenem and Cefdinir" were given for antimicrobrial coverage, "Desmopressin acetate" for anti-diuretic treatment, "Forcodine" for cough relief, "Ambroxol and acetylcysteine" for phlegm reduction, and continuous closed chest drainage was performed. The patient discharged after cough, wheezing, headache and other symptoms improved, and vital signs were stable. The patient has been followed up once a month for 17 months ongoing after discharge. At present, symptoms such as cough, sputum, and wheezing have improved considerably, and the mMRC score of dyspnea is 2 points. The reexamination of the chest X-ray shows that the absorption of lung exudates is better than before, and there is no recurrence of pneumothorax. Consider whether isolated diabetic insipidus is related to HSC, and if so, conduct an MRI, a biopsy, and other examinations as soon as possible.

Successful treatment of acute myocardial injury of Duchenne muscular dystrophy with steroids: a case report

BackgroundDuchenne muscular dystrophy (DMD) is an X-linked muscular disease which is caused by the absence of dystrophin. Troponin elevation with acute chest pain may indicate acute myocardial injury in these patients. We report a case of DMD that presented with ACP and troponin elevation, who was diagnosed with acute myocardial injury, and successfully treated with corticosteroids.Case presentationA 9-year-old with DMD was admitted to the emergency department with the complaint of acute chest pain. His electrocardiogram (ECG) revealed inferior ST elevation and serum troponin T was elevated. The transthoracic echocardiography (TTE) demonstrated inferolateral and anterolateral hypokinesia with depressed left ventricular function. An ECG-gated coronary computed tomography angiography ruled out acute coronary syndrome. Cardiac magnetic resonance imaging revealed mid-wall to sub-epicardial late gadolinium enhancement at the basal to the mid inferior lateral wall of the left ventricle and corresponding hyperintensity on T2-weighted imaging, consistent with acute myocarditis. A diagnosis of acute myocardial injury associated with DMD was made. He was treated with anticongestive therapy and 2 mg/kg/day of oral methylprednisolone. Chest pain resolved the next day, and ST-segment elevation returned to normal on the third day. Troponin T decreased in the sixth hour of oral methylprednisolone treatment. TTE on the fifth day revealed improved left ventricular function.ConclusionDespite advances in contemporary cardiopulmonary therapies, cardiomyopathy remains the leading cause of death in patients with DMD. Acute chest pain attacks with elevated troponin in patients with DMD without coronary artery disease may indicate acute myocardial injury. Recognition and appropriate treatment of acute myocardial injury episodes in DMD patients may delay the development of cardiomyopathy.

Evaluation of the Role of Hs-Troponin among Patients with Acute Coronary Syndrome in Tertiary Hospital

Introduction: Acute Coronary Syndrome (ACS) is a life-threatening medical emergency that requires prompt diagnosis and management. Traditional cardiac Troponin I has been the gold standard for the diagnosis of ACS, but the development of high-sensitivity cardiac Troponin assays, such as Hs-Troponin, has shown promise in improving the accuracy of diagnosis. This study aims to evaluate the role of Hs-Troponin among patients with ACS in a tertiary hospital in Bangladesh. Additionally, the study seeks to identify the prevalence of risk factors for ACS, such as hypertension and hypercholesterolemia, in this population. The findings of this study may inform clinical decision-making and guide the development of effective prevention and management strategies for ACS in Bangladesh. Methods: This retrospective cross-sectional observational study was conducted at the Department of Cardiology, 250 Bedded District Hospital, Jashore, Bangladesh. The study duration was 1 year, from December 2021 to December 2022. Initial sample size was 400 patients, but patients under 18 years of age and those with incomplete data were excluded, resulting in a final sample of 175 non-ACS and 160 ACS patients. Data was collected after obtaining ethical approval. Mean values and standard deviations were calculated for continuous variables such as cardiac troponin and Hs-troponin levels, and compared using independent t-tests. Categorical variables were compared using Chi-square tests. Cardiac troponin levels of ≤0.04 ng/mL and Hs-Troponin range of ≤14 pg/mL were considered normal. Result: Mean age was 50.2 (±14.3) in the Non-ACS group and 58.7 (±12.6) in the ACS group (p &lt; 0.001). The gender distribution differed significantly, with 53.14% males in Non-ACS and 66.25% in ACS (p &lt; 0.05). Mean onset of chest pain was 3.1 (±0.21) in Non-ACS and 2.9 (±0.42) in ACS (p &gt; 0.05). Mean systolic blood pressure was higher in ACS (138.19±4.18) than Non-ACS (127.21±5.29) (p &lt; 0.001). Mean BMI was similar in ....

Man With Acute Chest Pain.

A previously healthy 47-year-old man presented to the emergency department with a sudden attack of severe chest pain during a car ride. It was persistent, unrelated to breathing, and accompanied by epigastric and back pain. On physical examination, he was conscious, with a blood pressure of 125/91 mmHg, a pulse rate of 75 beats/min, and afebrile. He presented no tenderness on palpation of his chest, back, and epigastrium. The ECG showed sinus rhythm with early repolarization (Figure 1). The results of the laboratory tests were normal, including serum troponin levels. Point-of-care ultrasound was performed (Figure 2, A and Video E1), and the diagnosis was confirmed by contrast-enhanced computed tomography (Figure 2, B, and Figure 3).Figure 2A, Point-of-care ultrasound of echocardiogram in parasternal long axis view demonstrated well-defined heterogeneous mass in the posterior mediastinum (asterisk), surrounding the descending aorta (arrowhead), and compressed the LA. B, The findings as seen on computed tomography angiography. Ao, aortic root; LA, left atrium; LV, left ventricle.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3A reconstructed maximum intensity projection image of computed tomography angiography showed extravasation and pseudoaneurysm of left 10th intercostal artery (arrow).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Spontaneous rupture of an intercostal artery. The patient received modified thoracic endovascular aortic repair and was hospitalized in the vascular surgery department. He was asymptomatic at discharge 4 days later and at the 2-week follow-up. Intercostal artery rupture is a rare disease, which can be associated with neurofibromatosis type 1, aorta coarctation, or trauma. The rupture of the intercostal artery could cause hemothorax, retroperitoneal hemorrhage, hemorrhagic shock, or respiratory failure. The diagnosis is based mainly on the computed tomography study. Early diagnosis is critical and challenging. In our case, the point-of-care ultrasound evaluation unveiled posterior mediastinum hematoma and eventually led to the final diagnosis. The management of an intercostal artery rupture in an individual ranges from careful observation to interventions, including transcatheter arterial embolization or surgery.1Izumoto S. Abe T. Koroki T. et al.A 48-year-old man presenting as an emergency with severe back pain, a large anterior paravertebral hematoma, and spontaneous rupture of the right 9th intercostal artery successfully managed by transcatheter arterial embolization: a case report.Am J Case Rep. 2022; 16e934173Google Scholar eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI4Y2VkNjBjMDgwZTg2NjAwNjc4ODI4OTkxZDk3YzUxYyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc1NzYwNDkwfQ.aGsxHuVrG046F2O67mFbDXdJB6uhIDHZjF-VVT7E1fYtLhHfdCLzNltHhT0RT158jaWjvBTv25NgeV81SQjlTrQW-79H4JOf69to6txArmtMBwW2KcFvDfw24ax6S2r6eABepzn1FIyvo4b0aFRpxFkEthGCjuyrn9MZbsjU2tg8FBSfRnHu0VqpnjHRjMZJJiLuukNRQ0ocM3iPypHr8FHzzoKThdbwG5SzMrnWWJ3otinL-F76RTTvuG6Y68GHo2Wn1r7ZmmfjYNetoc0JyR0Ygn8MTis-gHNwDBhNs2wB1vLQKM9e-n3tTxVBHqyTxCBKv-IqT8cf2TBvxcHhDQ Download .mp4 (2.78 MB) Help with .mp4 files Video E1Bedside echocardiogram in parasternal long axis view demonstrated a hematoma (asterisk) in the posterior mediastinum, surrounding the descending aorta (arrowhead), and compressing the left atrium (visible at 00:00 to 00:05). Point-of-care ultrasound of the epigastrium revealing a well-defined hypoechoic lesion (arrow) posterior to the descending aorta, correlated with the pseudoaneurysm seen on computed tomography angiography (visible at 00:06 to 00:12).

Question: Uncommon masquerader of inferior STEMI.

A 54-year-old man brought into the emergency department with acute onset of chest pain. He had background history of hypertension. Physical examination was notable for an elevated blood pressure of 165/85 mmHg. His chest was clear to auscultation and his heart sound did not reveal any murmur. His electrocardiograph showed inferior ST Elevation Myocardial Infarction (STEMI) as shown in Figure 1A. Patient was transferred urgently to the catheterization laboratory for coronary angiography. Ultrasound guided vascular access was obtained in the right femoral artery. JL-4 catheter was used but noted to be catching in the ascending aorta. JR-4 guide into aortic root with non-selective shot is shown in Figure 1B (see Supplementary material online, Video S1). A pigtail aortogram was performed as shown in Figure 1C (see Supplementary material online, Video S2). ... Supplementary material is available at European Heart Journal: Acute Cardiovascular Care online.

The value of dual-energy computed tomography in the evaluation of myocarditis

The inflammation of the heart muscle is referred to as acute myocarditis. Cardiac magnetic resonance imaging (CMR) has become the primary method for a non-invasive assessment of myocardial inflammation. However, there are several drawbacks of CMR. During the last decade, dual energy computed tomography (DECT) has been used in cardiac imaging. The current study aims to assess the efficacy and feasibility of DECT in acute myocarditis and compare the results to CMR. This prospective study included patients who had myocarditis but no coronary artery pathology. Two observers evaluated the patients for acute myocarditis using DECT and CMR. CMR was performed on 22 patients within 24 hours of DECT, which was administered within 12 hours following the onset of chest pain. Inter-observer agreement was tested with Cohen's Kappa coefficient, and Spearman's correlation was used to examine the possible correlations. A P value of <0.050 was accepted as statistically significant. The DECT and CMR agreement was significant for transmural diagnoses, excellent for subepicardial and intramyocardial diagnoses, and perfect for nodular and band-like patterns. The findings of this study showed that the dark areas on the color-coded iodine map created with DECT were strongly correlated with CMR in acute cases of myocarditis. In addition, DECT is a robust imaging method that can also be used in the diagnosis of acute myocarditis. Furthermore, it provides information about coronary arteries faster and more reliably than magnetic resonance imaging without any limitations.

Mitral valve chordal rupture against the background of cardiac SARS-CoV-2 infection. Cases series

In an ever-changing information flow on coronavirus disease 2019 (COVID-19) pandemic, we describe a case series of mitral valve chordal rupture (MVCR) in non-comorbid middle-aged men that occurred over a period of 3 to 5 weeks after Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) infection. With significant advances in the prevention of acute rheumatic fever, the treatment of bacterial endocarditis and acute coronary syndrome, acute mitral regurgitation has become a relatively rare diagnosis. During the pandemic, there has been a surge in the incidence of spontaneous MVCR, and new data on the problem are accumulating. The presented case series are united by the fact that the infection symptoms were mild, followed by signs of probable endomyocarditis, unrecognized in time, and acute mitral valve regurgitation developed against the background of physical provocation (exercise and cough). Two patients had previously been diagnosed with mitral valve prolapse (myxomatous degeneration and connective tissue disease). Two patients were successfully operated on in different clinics. The described cases emphasize that the consequences of inflammation persistence may be more severe than the primary viral damage, which determines the importance of a comprehensive examination and long-term follow-up. To date, the differential diagnosis of patients with sudden onset of dyspnea and chest pain associated with an infectious process should include MVCR.

Meteorin-like protein decreases in acute coronary syndrome.

This study aims to investigate the level of Meteorin-like protein (METRNL) and C-reactive protein (CRP), total antioxidant status (TAS), total oxidant status (TOS), and oxidative Stress Index (OSI) which are known to be related with inflammation in patients with acute myocardial infarction (AMI). A total of 64 patients diagnosed with AMI at the emergency service and 56 healthy controls were included in this study. Levels of METRNL, CRP, TAS, TOS, OSI, and other basic biochemical parameters and hemograms of the study groups were analyzed. A significant difference was found between groups in terms of level of glucose (GLU) (p<0.001), urea (p<0.001), creatinine (CRE) (p<0.001), Troponin-I (TROP) (p<0.001), CRP (p<0.001), white blood cell (WBC) (p<0.001), TAS (p<0.001), TOS (p<0.001), OSI (p<0.001) and METRNL (p<0.001). It was determined that there was a significant negative correlation between the level of METRNL with the time from the onset of chest pain until emergency department admission (r=-0.345, p=0.005) and the level of troponin (r=-0.372, p=0.002) in 64 patients diagnosed with the acute coronary syndrome (ACS). However, it was determined that a significant correlation was not present with age (r=-0.058, p=0.650), BMI (r=0.092, p=0.472), TAS (r=0.079, p=0.533), TOS (r=0.113, p=0.374), OSI (r=0.042, p=0.740), CRP (r=-0.192, p=0.129) level. When we accept the cut-off value of METRNL ≤2.55 ng/mL in ROC analysis, its sensitivity and specificity were determined as 82.81% and 80.36%, respectively in differentiating AMI patients from the healthy control group. It was found that the level of METRNL decreased in AMI patients and a negative correlation was present between the level of METRNL with the time from the onset of chest pain until emergency department admission and the level of troponin. In addition, it was determined that the level of TOS and OSI were significantly increased and the level of TAS decreased considerably compared to the healthy control.

Early stent thrombosis in Kounis syndrome - a case report

Introduction. Kounis syndrome is a simultaneous manifestation of acute coronary syndrome and conditions associated with mast cell activation, such as allergies or anaphylactic reactions. We present early stent thrombosis in a female with an atopic constitution without previous atherosclerosis of coronary arteries. Case report. A 50-year-old woman with typical anginal pain was admitted to the Clinic for Cardiology, University Clinical Center Nis. A few hours earlier, she had passed by a linden tree in bloom. She immediately felt chest pain, paresthesia and numbness in her left arm throat tightness, heaviness of the tongue, and swelling of the lips. The symptoms disappeared for 60 min after taking 10mg of loratadine, but then they recurred. On the electrocardiographic (ECG) findings, 30 minutes after admission, ST elevation was seen in leads D2, D3, aVF, and V6. She underwent an emergency percutaneous coronary intervention procedure. Occlusive thrombosis was seen in the ostium of the left anterior descending (LAD) coronary artery. A sirolimus-coated stent was placed and thrombolysis in myocardial infarction (TIMI) 3 flow was obtained. A few hours after the intervention, the patient reported a new onset of chest pain followed by ventricular fibrillation (VF), DC shock, and the occurrence of new ST-segment elevation in aVR and V1?V3 on the ECG. Repeated angiography showed acute instent thrombotic occlusion. Balloon angioplasty was performed, which restored TIMI 3 flow in LAD coronary artery. Anticoagulant and corticosteroid therapy was administered. Three days after the intervention, optical coherence tomography imaging was performed, which showed good stent expansion and apposition, without atherosclerosis and thrombosis. Conclusion. Coronary angiography proved type I Kounis syndrome after exposure to an allergen, and type III Kounis syndrome developed shortly after stent placement when acute instent thrombosis occurred. Newly described causes of acute and sub-acute stent thrombosis in type III Kounis syndrome are stent-associated hypersensitivity reactions.

Ulmonary or not the question is now? Pulmonary manifestation of non-pulmonary diseases

We presents four patients with respiratory symptoms and radiological finding but without pulmonary diagnosis at the end. The first case is mitral chordae rupture, which is understood as a COPD exacerbation due to the dyspnea and fatigue. Considering normal auscultation finding, not smoker, the overall finding did not indicate COPD. Urgent heart ultrasound gave right diagnosis. The second was admitted as bilateral pneumonia. CT scan showed that it was a large intestinal hernia. The third case was presented as pleural effusion after the onset of acute chest pain. Profile radiography and CT scan diagnosed aortic aneurysm dissection and the patient underwent emergency surgery. The fourth patient underwent chest X-ray as part of the preoperative preparation of gallbladder calculosis, where a nodular tumor shadow was seen. CT scan showed that was a pericardial cyst. Imaging findings must be correlated with clinical manifestations. This paper presents some of the faces of non-pulmonary diseases with respiratory manifestations that can lead us a misdiagnosis and sometimes lethal outcome. A multidisciplinary approach, more diagnostic procedures with an adequate history of illness will give us the right diagnosis. In this way, the patient will receive appropriate treatment

Prognostic Relevance of Serum Ferritin on Short Term and Long term Outcome In Patients With Acute Myocardial Infarction

Objective-Over the decades coronary artery disease appears to be an emerging cause of mortality andmorbidity. Elevated serum ferritin as a risk factor for development of AMI. However its role with regard tooutcome and prognosis of AMI still remains a matter of debate. Hence, the present study was aimed toestimate the prognostic relevance of serum ferritin in relation to short term and long term survival outcomes inpatients with AMI.Methods- Out of a total number of 100 patients,with first AMI (50 of STEMI &amp; 50 of NSTEMI diagnosis)admitted within 12 hours of the onset of chest pain to coronary care units at MKCG MedicalCollege&amp;Hospital over a period of 1 year. Serum ferritin was measured using an ELISA assay by a special kit.The patients were divided into three groups according to Serum ferritin level.i.e.(1sttertile:&lt;120 ng/ml,2ndtertile:120 to 220 ng/ml and 3rd tertile:&gt;220 ng/ml).Baselinecharacteristics,LVEjection Fraction, Killipfunctional class and outcomes were compared among three different groups of serum ferritin.Results:There was a significant correlation between serum ferritin and LV ejection fraction(p=0.01),Killipclass(p=0.03) and mortality(p=0.03). Lower and higher levels of ferritin (1st and 3rd tertiles, ≤ 120; &gt;220 ng/ml,respectively) were associated with a higher incidence of HF during hospitalization and death at 1 year.Conclusion:Raised serum ferritin is associated with worse short term and longterm outcome followingmyocardial infarction.

Efficacy of Accelerated Streptokinase Infusion in the Treatment of St-Elevation Myocardial Infarction

OBJECTIVES To determine the efficacy of accelerated streptokinase (SK) in patients with acute ST-elevation myocardial infarction (STEMI). METHODOLOGY This Descriptive study was done in the Department of Cardiology, Hayatabad Medical Complex over a period of 6 months from august 2020 to February 2021. Age ranged between 35-70 years. Both males and females presenting with acute ST elevation MI, patients within 6 hours of the onset of chest pain were included in the study. RESULTS Among 144 patients age distribution was analyzed as 50(35%) patients were in age 35-50 years, and 94(65%) patients were in age 51-70 years. The mean age and standard deviation were 61± 8.19. Gender distribution was analyzed as 88(61%) patients were male and 56(39%) patients were female. Status of BMI was analyzed as 69(48%) patients had BMI ≤27 Kg/m2 and 75(52%) patients had BMI &gt;27 Kg/m2. CONCLUSION The accelerated SK infusion regimen of 1.5 MU in 20 min is safe and well tolerated with significantly faster and higher clinical reperfusion rates, more preserved LV systolic function, less atrial and ventricular sustained arrhythmias, and less in-hospital and 1-year mortality rates in acute STEMI.

Acute Myocardial Infarction Following the Consumption of Energy Drink in a 28-Year-Old Male: A Case Report.

Excessive intake of energy drinks is increasingly realized to have a detrimental effect on platelet and endothelial functions with resultant hypercoagulable state and consequently increased risk of thrombosis. A 28-year-old man of African origin presented to the emergency department with an 8-hour history of retrosternal chest pain. His symptoms started 4 hours after consuming 5 cans (1250 cc) of an energy drink whose principal ingredients are caffeine, taurine, sugar, and glucuronolactone. His past medical and surgical history was unremarkable, and he had no apparent cardiovascular risk factor. Physical examination was unremarkable; however, electrocardiogram and echocardiogram showed features of anterolateral myocardial infarction (STEMI). Catheterization confirmed a 100% thrombotic occlusion of the proximal left anterior descending (LAD) artery and revascularization with a drug-eluting stent was successful. In conclusion, sudden onset of chest pain following energy drink consumption should raise an index of suspicion for acute coronary syndrome. With the preponderance of data suggesting increased incidence of energy drink-associated coronary events, it is prudent to advocate a limited consumption of such beverages.

A Rare Case of Peripartum Cardiomyopathy Followed Up for Intracardiac Thrombus and Sudden Embolism of Right Coronary Artery: A Case Report and Review of the Literature

Peripartum cardiomyopathy (PPCM) is a rare disease with high mortality in which dilated heart failure occurs in the last month of pregnancy or within 5 months after delivery, without any other etiology or pre-existing heart disease. Sometimes, it may present with intracardiac thrombus and associated life-threatening embolic complications. Here, we will present the management of a 28-year-old patient who was diagnosed with PPCM and intracardiac thrombus immediately after delivery and was followed up in the intensive care unit, in which an inferior myocardial infarction was detected in the electrocardiogram taken for sudden onset chest pain. Although peripheral thromboembolism is occasionally detected in PPCM patients with intracardiac thrombus, coronary embolisms is not common. Presentation with coronary embolism in patients with PPCM has been described in only 4 cases in the literature, but to the best of our knowledge, this is the first case to describe embolism to the right coronary artery.

Extensive Epipericardial Fat Necrosis in a Case of Metastatic Adenocarcinoma of Lung

Epipericardial fat necrosis is an uncommon benign and self-limiting condition that leads patients to the emergency department owing to the onset of acute pleuritic chest pain. Fat necrosis in adipose tissue can occur at various sites: in the breast and subcutaneous fat after trauma, peripancreatic fat in pancreatitis, and epiploicappendagitis.[1,2] Rarely, it may occur within the epipericardial fat. Since the first description by Jackson et al.,[3] only 35 cases have been published in the English literature, and extensive epipericardial fat necrosis (EFN) is currently described as an extremely rare disease.[4] The aetiology of EFN remains unknown, but some theories have been proposed to explain its origin. Acute torsion of a vascular pedicle is described in some cases, although the presence of a vascular pedicle has been described in only two patients who underwent surgery.[4] Furthermore, increased intrathoracic pressure due to heavy lifting or Valsalva's manoeuvre might trigger rapid changes in capillary pressure, leading to haemorrhagic necrosis, especially if pre-existing structural abnormalities of the adipose tissue, such as lipoma, hamartoma or lipomatosis, are present.[5] Both males and females are affected, and neither age predilections nor pre-disposing factors have been described.[4]

Acute Severe Mitral Regurgitation Secondary to Papillary Muscle Rupture: A Rare Mechanical Complication of Acute Myocardial Infarction

Acute myocardial infarction in current era is detected promptly and emergent percutaneous intervention is initiated in most part of the world as a standard of care which has led to significant reduction in all the complications associated with acute myocardial ischemia. A 46-year-old man presented with acute onset of chest pain and shortness of breathand was found to have a non ST-segment elevation myocardial infarction and acute mitral regurgitation due to papillary muscle rupture. This case describes a rare and potentially fatal mechanical complication of acute myocardial infarction. Use of transesophageal echo guides for the understanding the mechanism and guide the management.

Frequency of Left Anterior Descending Artery Involvement as a Culprit Vessel in Young Patient with ST Elevation Myocardial Infarction

Objective: To determine the frequency of left anterior descending artery involvement as a culprit vessel in young patient with ST elevation myocardial infarction (STEMI) at tertiary care hospital. Study Design: A cross-sectional study. Place and Duration: The Department of Cardiology, “National Institute of Cardiovascular Diseases, Karachi” Pakistan from October 2019 to April 2020. Methodology: Patients of both genders aged 25-45 years who were presented with onset of chest pain for more than 30 minutes with STEMI were included. All patients were clinically evaluated after detailed history. Routine biochemistry investigations were asked and ECG and echocardiography were performed. Frequency of left anterior descending artery involvement in patients with STEMI was noted. Results: In a total of 191 patients, mean age was 33.6±6.7 years while mean duration of chest pain was 42.5±8.3 minutes. There were 135 (70.7%) male and 56 (29.3%) female cases. In distribution of vessel disease, 76 (39.8%) had single vessel disease (SVD), 37 (19.37%) had double vessel disease (DVD) while 78 (40.84%) had triple vessel disease (TVD). Left anterior descending artery found to be positive in 88 (46.1%) patients. Practical Implications: To reduce the complications of STEMI, it is very important to increase the awareness and proper knowledge in the general public. Conclusion: Involvement of left anterior descending artery as a culprit vessel was fairly common in young patient with ST elevation myocardial infarction. Keywords: Left anterior descending artery, culprit vessel, ST elevation myocardial infarction, coronary artery disease

STUDY OF LIPID PROFILE OF PATIENT WITH ACUTE MYOCARDIAL INFARCTION

Background- There is discussion over the biomarker potential of using different lipid fractions to predict the risk of acute myocardial infarction (AMI). In order to compare the lipid profiles of 67 AMI patients, we looked at serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), and triglycerides (TG). Material And Method- A prospective, cross-sectional study was conducted in the SAIMS emergency/opd. Within 24hours of onset of chest pain. All patients admitted with AMI were included after providing informed consent. Results- Among 200 AMI Patients included 100 STEMI (ST- elevated myocardial infarction) patients, 100 NSTEMI (non-ST-elevated myocardial infarction) patients. The median age of STEMI patient was 57.7years while that of NSTEMI patients 60.3 years. BMI of STEMI 24.6 kg/m2 and NSTEMI 24.9 kg/m2. History of diabetes was present in 22% STEMI patient while that of NSTEMI patients 39%. History of hypertension is present in 52 % STEMI patient and 68% of NSTEMI patients. 49 % STEMI patients were currently smoking while only 36% among NSTEMI patients. Conclusion- The lipid paradox exists for STEMI patients LDL-C and TC levels and hospitalisation, 30-day, and 1-year mortality. NSTEMI patients have a lipid pseudo-paradox. HDL-C, myocardial infarction type, and hospital death are interrelated. These results need more study.

A CASE REPORT OF BEHÇET'S DISEASE WITH CORONARY ARTERY INVOLVEMENT

ABSTRACT&#x0D; We present a case of coronary artery thrombosis due to Behçet's disease. A 49-year-old female patient, diagnosed with Behçet's disease and followed up by us, applied to the emergency department with sudden onset of pressure-type chest pain, and was evaluated as acute myocardial infarction due to elevated cardiac enzymes and ST segment elevation in the anterior leads on electrocardiography (ECG). Coronary angiography revealed near-total thrombosis in the lumen of the left anterior descending artery (LAD) and in the circumflex (CX) artery,it was intervened with anticoagulant therapy. The patient's cardiac risk was found to be low and differential diagnosis was made in terms of myocardial infarction. Thereupon, the causes of hypercoagulability were investigated in the patient who was consulted to us, and acute phase reactants were found to be high. This was related to the coronary artery involvement of Behçet's disease and in addition to the treatment containing antiaggregant, statin, angiotensin receptor blocker, intravenous (IV) high-dose methylprednisolone and cyclophosphamide-mesna treatment was given for immunosuppressive purposes. It should not be forgotten that there may be vascular involvement due to Behçet's disease and coronary arteries may also be affected.