Diagnosis Of Acute Coronary Syndrome Research Articles

Abstract 16188: Fibrosis-4 Index in the Evaluation of Non-Ischemic Myocardial Injury in the Emergency Department

Introduction: Fibrosis-4 (FIB-4) is a recognized score of liver fibrosis that is associated with ischemic heart disease and cardiac death. The relationship between FIB-4 index and non-ischemic myocardial injury (ni-MI) has not yet been investigated. Hypothesis: There is an association between FIB-4 index and ni-MI in patients admitted to an emergency department (ED). Methods: This retrospective study included consecutive patients presenting at the ED within a six months’ timeframe, with at least one high-sensitivity cardiac troponin T (hs-cTnT) value and without acute coronary syndromes diagnosis. The cohort with ni-MI was compared with the group with normal hs-cTnT values (control group, CG). FIB-4 index was calculated by: {age [years]хAST [U/L]/ [platelet count (10 9 /L)хALT (U/L) 1/2 ]}. Results: A total of 3,853 patients were enrolled, 1,950 (51%) males, 64 [48-78] years, 1,372 (35.6%) with ni-MI. FIB-4 index was higher in the cohort with ni-MI compared to the CG (1.90 [1.28-2.78] vs. 1.01 [0.64-1.49]; p<0.001), with no sex differences (see Figure 1) . After adjustment for other covariates, FIB-4 index was independently associated with ni-MI in overall population (OR 1.468, 95% CI:1.195-1.803; p<0.001), and separately in both males and females (OR 1.385, 95% CI:1.054-1.822; p=0.02 and OR 1.407, 95% CI:1.017-1.946; p=0.039, respectively). FIB-4 index was positively correlated with hs-cTnT (Rho= +0.536, p<0.001), NT-proB-type Natriuretic Peptide (Rho= +0.280, p<0.001) and negatively with estimated glomerular filtration rate (Rho= -0.510, p<0.001). AUC of FIB-4 index for predicting ni-MI in the overall population was 0.790 (optimal cutoff: ≥1.46, sensitivity: 71.9%, specificity: 73.2%). Conclusions: FIB-4 index is independently associated with ni-MI in ED, without sex differences, and positively correlated with the grade of cardiac injury, volume overload and renal dysfunction.

2023 Guidelines on Coronary Artery Disease: At a Glance

The guidelines have been released in the recent ESC congress held in Amsterdam, Netherlands. The summary is in two headings, new recommendations and change of recommendations compared to the previous guidelines. The wording to use classes of recommendations— is recommended – Class I, should be considered – Class IIa, may be considered – Class IIb, not recommended – Class III. In this guidelines of ACS, both ST segment elevation myocardial infarction and non ST segment elevation acute coronary syndrome diagnosis, management are addressed combinedly rather than separately as done in previous guidelines.Figures emphasizing the importance of evaluation of symptoms, diagnosis, and management are the highlights of the guidelines. Example: At initial assessment think ACS − Abnormal ECG, Clinical context, Stable patient?

Intervensi Mengontrol Nyeri dan Ansietas Pada Pasien dengan Sindrom Koroner Akut

This literature study aims to identify complementary therapies that can be used to reduce pain and anxiety in patients with acute coronary syndrome. The research method uses literature study, articles collected through the Google Scholar, EBSCO, Science Direct, Scopus and ProQuest databases in the form of articles published in 2018-2022 using the PRISMA approach. The article search strategy uses keywords/MeSH, namely "Complementary therapy" AND "Nursing Intervention" AND "Pain" AND "anxiety" AND "Acute Coronary Syndrome". As a result of the research, a total of 9 articles containing complementary therapy interventions in controlling pain were selected based on the inclusion criteria of patients with a medical diagnosis of acute coronary syndrome and were human clinical trials. In conclusion, inhalation of aromatherapy Melissa essential (lemon balm) and peppermint as well as thermotherapy are effective in the patient's acute pain phase. Deep breathing and massage relaxation interventions can reduce anxiety in ACS patients.
 
 Key words: Anxiety, Pain, Acute Coronary Syndrome, Complementary Therapy

VASOSPATIC ANGINA IN GRAVES DISEASE

Category A Thyroid hormones play a key role in the growth and metabolism of almost all tissues. Any abnormal increase or decrease of these hormones can cause impairment in functioning of almost all organ systems. Hyperthyroidism has been associated with a number of cardiac manifestations including tachycardia, cardiac arrhythmia especially AF, cardiomyopathy, angina or even myocardial infarction. Here we present a case of a 38 year old female with no known comorbidities who presented to medicine casualty with complaints of recurrent episodes of typical angina lasting 15–20 min or more. Her vitals showed mildly elevated blood pressure of 150/90 mmHg and tachycardia. An ECG taken immediately showed ST segment depression in the anterolateral leads. Cardiac biomarkers were negative. A provisional diagnosis of acute coronary syndrome was made and treatment started. Echo was found to be normal. Patient continued to have recurrent episodes of angina. Coronary angiography was normal. On detailed evaluation patient gave a history of palpitation, loss of weight, diarrhoea and increased sweating in the last 3 months. Detailed physical examination revealed a painless neck swelling. Laboratory tests showed Hb – 12 g/dl, serum K – 4.1 mmol/dl, Ca – 9.2 mg/dl, LFT and RFT normal, fT3 – 22.9, fT4 – 64.2, TSH <0.01 suggestive of hyperthyroidism. On further evaluation she was found to be positive for TSH receptor antibody and was diagnosed with Grave’s disease. She was started on anti-thyroid drugs and propranolol. Nitrates were stopped after 6 months and patient remains asymptomatic on treatment. Conclusion: Hyperthyroidism may present in numerous ways and may even be life threatening. This case highlights the importance of checking the thyroid status of patients, especially in the younger age group, with no obvious cause or risk factors presenting with angina. They may not always have classical symptoms of hyperthyroidism. A delay in diagnosis can result in undue complications and unnecessary interventions. Most of these patients were found to lead a normal life with proper medications once diagnosed.

The clinical significance of ischaemia-modified albumin in acute coronary syndrome and hypertension.

Early diagnosis of acute coronary syndrome is more and more important because of its mortality and morbidity. Hypertension is one of the pathogenesis of acute coronary syndrome, which often leads to stenosis and ischaemia. Ischaemia-modified albumin is sensitive for the occurrence of ischaemia, which attracted us in the significance of ischaemia-modified albumin in patients with chest pain, especially patients complicated with hypertension. In total, 200 patients with acute chest pain were included in the study. According to the diagnostic criteria, patients were divided into acute coronary syndrome group and non-ischaemic chest pain group. Cardiac biomarkers were measured with 30 minutes in emergency department, including cardiac troponin T, creatine kinase MB, and ischaemia-modified albumin. Receiver operating characteristic curve (ROC) analysis was used for the sensitivity and specificity of ischaemia-modified albumin in the early diagnosis of acute coronary syndrome. Comparisons between ischaemia-modified albumin and cardiac Troponin T were done between groups. The demographics in two groups were not significantly different in most aspects. Compared with non-ischaemic chest pain group, serum levels of ischaemia-modified albumin and cardiac Troponin T were significantly higher in acute coronary syndrome group. ROC analysis showed that ischaemia-modified albumin had a good sensitivity and specificity in early diagnosis of acute coronary syndrome. The level of ischaemia-modified albumin in acute coronary syndrome patients with hypertension was higher than that in non-ischaemic chest pain patients. In patients complained with acute chest pain, the serum measurement of ischaemia-modified albumin is potential valuable for the early diagnosis of acute coronary syndrome, especially combined with ECG. The serum level of ischaemia-modified albumin in acute coronary syndrome patients is significantly associated with hypertension.

Characterisation of Patients with Acute Coronary Syndrome: A 10-Year Experience

Introduction: Coronary intervention is a therapeutic method for acute coronary syndrome. Objectives: Characterise patients with acute coronary syndrome treated by percutaneous coronary intervention. Method: Analytical, observational, retrospective, and cross-sectional study of 1,469 patients with the diagnosis of acute coronary syndrome, treated with percutaneous coronary intervention at the Hermanos Ameijeiras Hospital, Havana, Cuba, between 2010–2019. Results: The mean age of the patients was 61.1±10.6 years, 72% were male, and 68.3% had acute coronary syndrome without persistent ST-segment elevation. The commonest risk factor was hypertension (69%). Radial access was used in 75.0% of procedures, and 82.0% had a single occluded epicardial coronary artery (42.4% anterior descending artery, 29.7% right coronary artery). One (63.3%) bare metal stent was implanted in 70.7% of patients, with a 96.0% angiographic success rate. There were complications in 1.1% of cases. Diabetes was significantly associated with the failure of the procedure. Conclusions: Most of the patients were middle-aged, with hypertension and a diagnosis of non-ST-segment elevation acute coronary syndrome, where the most frequently treated artery is the left anterior descending artery, and the radial artery is the most commonly used vascular access route with an elevated number of successful procedures. The presence of diabetes is significantly associated with the failure of the procedure.

Acute Coronary Syndrome Induced by Carbon Monoxide Intoxication: A Case Report

Carbon monoxide (CO) intoxication is the most frequent etiology of toxicological morbidity and mortality in the world. If the neurological manifestations are in the foreground, then cardiovascular signs of myocardial damage by necrosis are possible, which can result in angina, an acute coronary syndrome followed by myocardial stupor, collapse or even cardiac arrest.
 We report a case of CO intoxication inducing an acute coronary syndrome without ST elevation in an elderly diabetic patient with no coronary artery disease history.
 Diagnosis: This patient presented a CO intoxication after an accidental exposure; the electrocardiogram showed a depressed ST segment of the inferior and apico-lateral leads; cardiac enzyme troponins gradually increased. Echocardiography showed a preserved systolic function with a disorder of the heart wall motions. Coronary angiography revealed significant lesions of the proximal left anterior descending artery (LAD) and the first marginal evoking a diagnosis of acute coronary syndrome induced by CO intoxication.
 Interventions: His management consisted of the administration of hyperbaric oxygen therapy, a platelet aggregation inhibitor (aspirin plus clopidogrel), an anticoagulant (low molecular weight heparin) and myocardial support (Bisoprolol). Coronary angiography and the placement of two active stents were performed after 24hrs onset diagnosis.
 Results: The patient had a good clinical outcome under hyperbaric oxygen therapy, complete revascularization of the angiographic lesions which showed improvement in cardiac function and a slight improvement of heart wall motion on echocardiography performed on the 5th day. After 6 days, the patient had recovered well and was discharged from the hospital without chest discomfort, dizziness or headache.
 Lecture: This case suggests that the symptoms of carbon monoxide intoxication are complex and diverse. This can manifest as a primary hypoxic symptom or cause an exacerbation of underlying diseases due to hypoxia. Therefore, patients with carbon monoxide intoxication should actively seek a comprehensive cardiac examination to ensure early diagnosis. Whenever necessary, coronary angiography and stent implantation should be performed to improve the patient's chances of survival.

A Case of Infective Endocarditis Complicated with an Acute Coronary Syndrome, Cerebral Septic Infarction, and Sepsis

Infective endocarditis (IE) is a rare and highly mortal infectious disease. A 41-year-old male patient who was being followed with the diagnosis of acute coronary syndrome, acute cerebrovascular disease, meningitis and sepsis, was diagnosed with IE with the presence of vegetation on the mitral valve and Staphylococcus aureus growth in his blood culture. The patient was treated with cefazolin plus vancomycin. We present this case to remind that IE can cause various complications and careful examination may be required for the diagnosis.

Novel Biomarkers and Their Role in the Diagnosis and Prognosis of Acute Coronary Syndrome.

The burden of cardiovascular diseases and the critical role of acute coronary syndrome (ACS) in their progression underscore the need for effective diagnostic and prognostic tools. Biomarkers have emerged as crucial instruments for ACS diagnosis, risk stratification, and prognosis assessment. Among these, high-sensitivity troponin (hs-cTn) has revolutionized ACS diagnosis due to its superior sensitivity and negative predictive value. However, challenges regarding specificity, standardization, and interpretation persist. Beyond troponins, various biomarkers reflecting myocardial injury, neurohormonal activation, inflammation, thrombosis, and other pathways are being explored to refine ACS management. This review article comprehensively explores the landscape of clinically used biomarkers intricately involved in the pathophysiology, diagnosis, and prognosis of ACS (i.e., troponins, creatine kinase MB (CK-MB), B-type natriuretic peptides (BNP), copeptin, C-reactive protein (CRP), interleukin-6 (IL-6), d-dimers, fibrinogen), especially focusing on the prognostic role of natriuretic peptides and of inflammatory indices. Research data on novel biomarkers (i.e., endocan, galectin, soluble suppression of tumorigenicity (sST2), microRNAs (miRNAs), soluble oxidized low-density lipoprotein receptor-1 (sLOX-1), F2 isoprostanes, and growth differentiation factor 15 (GDF-15)) are further analyzed, aiming to shed light on the multiplicity of pathophysiologic mechanisms implicated in the evolution of ACS. By elucidating the complex interplay of these biomarkers in ACS pathophysiology, diagnosis, and outcomes, this review aims to enhance our understanding of the evolving trajectory and advancements in ACS management. However, further research is necessary to establish the clinical utility and integration of these biomarkers into routine practice to improve patient outcomes.

Evaluation of the analytical and clinical performance of a new high-sensitivity cardiac troponin I assay: hs-cTnI (CLIA) assay.

Cardiac troponin (cTn) is the key biomarker for diagnosis of acute coronary syndrome (ACS). We performed a complete assessment of the high-sensitivity cardiac troponin I (hs-cTnI) (CLIA) assay on the analytical performance and clinical diagnostic performance, which was compared with Abbott ARCHITECT hs-cTnI assay. Sex-specific 99th percentile upper reference limits (URLs) were determined from a healthy population of 424 males and 408 females. High-sensitivity performance was assessed by examining the imprecision at sex-specific URLs and the detectable results above LoD in a cohort of healthy population. The diagnostic performance of the hs-cTnI (CLIA) assay was validated in a population of 934 patients with suspected ACS. The 99th percentile URLs were 15.3 ng/L for female, 31.3 ng/L for male and 24.2 ng/L for overall population. The total imprecision near the sex-specific 99th percentile URLs were <5 %. 76.74 % of females, 97.12 % of males and 86.69 % of overall population had cTnI values exceeding the LoD, which met the criteria of high-sensitivity troponin assay. Nocross-reactivity or interference was identified. The diagnostic sensitivity, specificity, PPV, NPV, and AUC of hs-cTnI (CLIA) assay were 97.97 , 90.70, 79.02, 99.21 % and 0.9885, respectively, which were comparable to ARCHITECT hs-cTnI assay. hs-cTnI (CLIA) assay is a high-sensitivity troponin I method with high precision, sensitivity and specificity. The clinical diagnostic performance of hs-cTnI (CLIA) is comparable to the established ARCHITECT hs-cTnI assay. Mindray's hs-cTnI (CLIA) assay is an attractive alternative for diagnosis of myocardial infarction with a high level of accuracy and safety.

Sex–related differences in non-ischemic myocardial injury in the emergency department: A real-world perspective

BackgroundMyocardial injury is associated with adverse outcomes. No data are reported about sex differences in incidence and factors associated with myocardial injury in an emergency department (ED) setting from a real-world perspective. We aimed to assess whether sex plays a major role in the diagnosis of myocardial injury in the ED. MethodsIn this subanalysis of a retrospective study, patients presenting at the ED with at least one high-sensitivity cardiac troponin T (hs-cTnT) value and without acute coronary syndromes diagnosis were compared. Results31,383 patients were admitted to the ED, 4660 had one hs-cTnT value, and 3937 were enrolled: 1943 females (49.4%) and 1994 males (50.6%). The diagnosis of myocardial injury was higher among men (36.8% vs. 32.9%, p < 0.01). Male sex was independently associated with myocardial injury. An older age, an elevated NT-proB-type Natriuretic Peptide and a lower estimated glomerular filtrate rate were independently associated with myocardial injury in both sexes. ConclusionsIn the ED, from a real-world perspective, myocardial injury occurred more frequently in males, and it was associated with older age and the presence of cardiac, lung, and kidney disease but not higher hs-cTnT values.

Rupture of a Spinal Dural Arteriovenous Fistula as a Differential Diagnosis of a Coronary Syndrome: Case Report

BACKGROUND AND IMPORTANCE: Spinal dural arteriovenous fistulas (SDAVFs) are the most common vascular malformation of the spine and can lead to progressive paraplegia if left untreated. However, because of their nonspecific clinical presentation, they are often misdiagnosed as other pathologies, such as discopathies or degenerative neuropathies, which can result in delayed diagnosis and treatment. CLINICAL PRESENTATION: A case of a 73-year-old female with a history of acute coronary syndrome who presented to the emergency department with sudden onset chest pain suggestive of an acute myocardial infarction is presented. Further evaluation revealed a subdural hematoma at T2-T5 and T8-L5, caused by a ruptured SDAVF at the T12-L1 level. The patient required emergency decompression surgery, but because of late diagnosis, she suffered a spinal cord injury with an ASIA-A classification. CONCLUSION: SDAVF is a disease with nonspecific initial symptoms, which can easily be mistaken for other pathologies. However, early recognition of the presence of the fistula, especially in cases of rupture, can improve prognosis and increase the chance of better outcomes. It is important to keep this condition in mind when evaluating patients with unexplained neurological symptoms and consider SDAVF as a differential diagnosis of acute coronary syndrome.

Analysis of Sensitivity, Specificity, and Predictive Values of High-Sensitivity Troponin T in a Secondary Care Setting: A Retrospective Cohort Study.

Background High-sensitivity cardiac troponin (hs-cTn) assays have significantly improved the early detection of myocardial injury and the diagnosis of acute coronary syndrome(ACS). Different diagnostic algorithms exist for the interpretation of hs-cTn in the management of patients with suspected ACS. This study analysed the diagnostic efficacy of hs-cTn using serial and single measurements while also shedding light on the challenges associated with the use of this assay. Methods We reviewed 189 results belonging to 120 unique patient episodes and records for troponin tests performed in a two-week period obtained from the West Cumberland Hospital, North Cumbria Integrated Care (NCIC), Whitehaven, England. These troponin tests were carried out based on the NCIC trust guidelines for the use of troponin assays in the management of acute coronary syndrome(ACS). A positive troponin test is defined using the NCIC trust guidelines and the National Academy of Clinical Biochemistry (NACB) guidelines. The case notes of the unique patients were reviewed to determine the outcome, which is defined as the clinical diagnosis on discharge of the patient following a cardiologist review. These outcomes were then used to calculate the sensitivity, specificity, and predictive values. We also determined the alternate diagnosis for false-positive tests. Results Using both guidelines to assess the clinical effectiveness of the troponin assay yields slightly varying results, with the single positive test of NACB demonstrating a higher sensitivity of 92.8% (>71.4%) and a slightly better negative predictive value of 97.8% (>96%). However, using the serial troponin measurements as per the NCIC trust guideline demonstrates a better specificity of 95.2% (>42.4%) and a positive predictive value of 66% (>17.5%). False positive results are identified, which are due to alternate diagnoses such as stable angina, myocarditis, heart failure, sepsis, and malignancy. Conclusion High-sensitivity troponin (hs-cTn) assays play a crucial role in the early detection and management of patients with suspected ACS. This study supports evidence that serial troponin measurements are more diagnostically accurate than single troponin measurements. Although hs-cTn assays offer significant advantages, there remain challenges and limitations that require careful interpretation and clinical correlation.

Translation, cultural adaptation and psychometric validation of the Arabic short version of the coronary artery disease education questionnaire (CADE-Q SV) in Saudi Arabia

ObjectiveTo translate, culturally adapt, and psychometrically validate the Arabic Coronary Artery Disease Education Questionnaire Short Version (CADE-Q SV). MethodsThe CADE-Q SV was translated to Arabic by two independent translators, followed by back-translation. Then, an expert panel of 10 healthcare providers and 10 patients reviewed the survey and provided input for content validity (CV) and clarity of items. For the psychometric analysis, 202 cardiac patients from Saudi Arabia completed the questionnaire, of which factor structure, internal consistency, construct, and criterion validity were assessed. ResultsItems were translated, and CV was confirmed. Items were rated based on relevance and understandability. The scale was finalized after changes in 5 items. Confirmatory factor analysis revealed 5 factors, all internally consistent: medical condition, risk factors, exercise, nutrition, and psychosocial health. Overall alpha was 0.84. Construct validity was established by significant associations between scores and occupation, educational level, family income, having a diagnosis of acute coronary syndrome or valve disorders and with a history of valve repair or replacement a coronary artery bypass graft procedure. Scores were significantly higher for those that participated in cardiac rehabilitation, confirming criterion validity. ConclusionsResults from this study confirm the validity and reliability of the CADE-Q SV in Arabic-speaking patients. InnovationThe CADE-Q SV can be used as a knowledge measurement to support clinical work and development of education intervention for Arabic patients.

Myocardite aiguë induite par la dengue

Dengue is a febrile viral illness transmitted by Aedes Aegypti mosquito with growing incidence, it could be associated with cardiovascular complication mediated by inflammation and notably acute myocarditis.We report the case of a 36-year old woman admitted in cardiology department with initial diagnosis of acute coronary syndrome and ultimately diagnosed to have an acute myocarditis induced by dengue infection; we describe diagnostic modalities and clinical evolution.

The Mediterranean Diet Scale (MDS): Translation and validation of the Arabic version.

The self-administered version of the Mediterranean Diet Scale (MDS) has been developed to test the inherent characteristics of this dietary pattern in a quick and simple way, due to the need of this assessment in the clinical and research setting. This study aimed to translate and psychometrically validate the self-administered MDS in Arabic (CRBS-A). The original (English) version was originally translated to Arabic, followed by back-translation. Next, 10 healthcare providers, followed by 10 cardiovascular disease (CVD) patients rated the face and content validity (CV) of materials, providing input to improve cross-cultural applicability. Then, 200 patients from Saudi Arabia completed the questionnaire, of which factor structure, internal consistency, criterion and construct validity were assessed. Content and face validity was supported based on experts and patients' reviews (ranges: CV scores 0.9-1.0/1.0 and clarity 3.5 to 4.5/5). Minor edits were made. Subsequent factor analysis revealed 4 factors consistent with the original version of the instrument, all internally consistent. Total CRBS-A α was 0.74. Criterion validity was confirmed by the significantly higher scores in patients who participated in CR. Construct validity was also established by significant associations between MDS scores and monthly family income, having the diagnosis of acute coronary syndrome or with a history of valve repair or replacement, being obese or having dyslipidemia. Overall, these results confirm the validity and reliability of the MDS in Arabic-speaking patients.

Which Treatment Strategy Is Preferred In The Octogenarians With Acute Coronary Syndrome?

To compare the efficacy of invasive and conservative strategy in the management of octogenarians with acute coronary syndrome. The retrospective study was conducted after approval from the ethics review committee of University of Health Sciences, Derince Training and Research Hospital, Turkey and comprised data from April 2020 to April 2021 related to octogenarian patients of either gender admitted to University of Health Sciences, Darica Farabi Training and Research Hospital, Turkey with acute coronary syndrome diagnosis. The data was divided into invasive group A and conservative group B. Data was analysed using SPSS 25. Of the 168 patients with median age 84(interquartile range: 81-86 years), there were 25(14.9%) in group A; 14(56%) males and 11(44%) females. There were 143(85.1%) patientsin group B; 70(49%) males and 73 (51%) females. Overall mortality was 111(66.1%); 11(44%) in group A, and 100(69.9%) in group B (p=0.012). Elevated alanine aminotransferase and invasive strategy were independent factors associated with mortality (p<0.05). The invasive strategy in the management of octogenarian patients presenting with acute coronary syndrome was found to be more efficient compared to the conservative strategy.

Diagnostic Performance of a Mnemonic for Warning Symptoms in Predicting Acute Coronary Syndrome Diagnosis: A Retrospective Cross-Sectional Study.

Objectives: We aimed to create a mnemonic for acute coronary syndrome (ACS) warning symptoms and determine its diagnostic performance. Methods: This retrospective cross-sectional study included patients visiting the emergency room with symptoms of suspected ACS during 2020-2021. The mnemonic was created using symptoms with an odds ratio (OR) for predicting ACS >1.0. The mnemonic with the highest OR and sensitivity was identified. Sensitivity analysis was performed to test the diagnostic performance of the mnemonic by patient subgroups commonly exhibiting atypical symptoms. Results: ACS prevalence was 12.2% (415/3,400 patients). The mnemonic, "RUSH ChesT" [if you experience referred pain (R), unexplained sweating (U), shortness of breath (S), or heart fluttering (H) together with chest pain (C), visit the hospital in a timely (T) manner] had the best OR [7.81 (5.93-10.44)] and sensitivity [0.81 (0.77-0.85)]. This mnemonic had equal sensitivity in men and women, the elderly and adults, smokers and non-smokers, and those with and without diabetes or hypertension. Conclusion: The "RUSH ChesT" mnemonic shows good diagnostic performance for patient suspected ACS. It may effectively help people memorize ACS warning symptoms.

Takotsubo cardiomyopathy prevalence and associated factors in patients presenting with a clinical picture of acute myocardial infarction in Palestine

BackgroundTakotsubo cardiomyopathy (TC) is a transient cardiac syndrome that manifests with symptoms resembling acute myocardial infarction (MI). It is characterized by temporary wall-motion abnormalities predominantly affecting the apical and mid-portions of the left ventricle, despite the absence of significant obstructive coronary disease. TC poses diagnostic challenges due to its resemblance to ST-segment elevation myocardial infarction.Our study aimed to determine the prevalence of TC and identify the factors associated with its occurrence in patients presenting with acute MI in Palestine.ResultsA retrospective analysis was conducted on a cohort of patients diagnosed with TC at Al-Makassed hospital. Women accounted for 90.7% of TC cases (95% CI 88.2–93.2%). The mean age of affected individuals ranged from 62 to 76 years. The most common presenting symptoms were chest pain (83.4%, 95% CI 80.0–86.7%) and dyspnea (20.4%, 95% CI 16.3–24.5%), often following an emotionally or physically stressful event. Electrocardiography (ECG) on admission indicated ST-segment elevations in 71.1% of cases (95% CI 67.2–75.1%), accompanied by mild elevations of Troponins in 85.0% of cases (95% CI 80.8–89.1%). Despite the initial severity, left ventricular ejection fraction (LVEF) improved from 20–49.9 to 59–76% within a mean time of 7–37 days. The in-hospital mortality rate was 1.7% (95% CI 0.5–2.8%), with complete recovery observed in 95.9% of cases (95% CI 93.8–98.1%) and rare recurrence. The underlying etiology is believed to involve exaggerated sympathetic stimulation.ConclusionsTC should be considered as a significant differential diagnosis in acute coronary syndrome (ACS) cases, particularly among postmenopausal women with a preceding stressful event. Our study provides insights into the prevalence and characteristics of TC in the Palestinian population. While stress has been recognized as a potential trigger for TC, further research is needed to explore if there are specific associations between occupation and other unique stressors in the Palestinian context and the prevalence of TC. The study’s results can raise awareness among healthcare professionals in Palestine about the prevalence and characteristics of TC in their patient population.

Reducing cardiac catheterization-related anxiety: acceptability of a complex intervention

Objective: To analyze the acceptability of people undergoing unscheduled cardiac catheterization about a complex nursing intervention (CI) to reduce anxiety. Methods: This is a qualitative and evaluative study of the acceptability of 15 participants who underwent cardiac catheterization regarding a nursing CI. Data collection was carried out in the emergency unit of a highly complex hospital in the city of São Paulo, specialized in cardiology. Participants had a diagnosis of Acute Coronary Syndrome and received the CI, consisting of a musical and educational component, called Education and Music Intervention to Reduce Anxiety (EMIRA). Data were collected from September to October 2021, and participants underwent a semi-structured interview. The guiding questions of the interview were elaborated based on Kazdin. The interviews were recorded and transcribed for Bardin’s content analysis. To analyze EMIRA participants’ participants, Representations of Everyday Life’s theoretical contribution was used. Results: Acceptability analysis in relation to EMIRA allowed identifying three categories: EMIRA complex intervention: new experience that helps to understand cardiac catheterization; Complex EMIRA intervention: an experience that generates satisfaction; and EMIRA complex intervention: an anxiety-relieving experience. Participants reported feelings of calm, relief, tranquility, satisfaction, and recommended using EMIRA. Conclusion: Participants’ experience with EMIRA was positive, suggesting good acceptability of CI by people awaiting unscheduled catheterization in the emergency unit.