Manifestation Of Acute Coronary Syndrome Research Articles

Myocardial infarction with non-obstructive coronary arteries in a young seropositive woman with human immunodeficiency virus: a case report and review of the literature

BackgroundElevated susceptibility to acute myocardial infarction and various cardiovascular diseases has been observed in individuals infected with the human immunodeficiency virus compared with the uninfected population, as demonstrated in numerous studies. The precise mechanism by which human immunodeficiency virus infection heightens the risk of acute myocardial infarction remains elusive. The manifestation of acute coronary syndrome in young patients with human immunodeficiency virus may deviate from the typical, displaying distinct pathophysiological and clinical characteristics. The occurrence of myocardial infarction with non-obstructive coronary arteries in young patients with human immunodeficiency virus poses diagnostic and treatment challenges.Case presentationWe present the case of a 46-year-old African woman with no traditional atherosclerotic risk factors. She was diagnosed with human immunodeficiency virus-1 infection 2 years prior to her current admission for chest pain. Her troponin levels were elevated, suggestive of acute coronary syndrome. Although coronary angiography ruled out coronary artery stenosis, it revealed mild myocardial bridging in the left anterior descending artery. Cardiac magnetic resonance imaging confirmed myocardial infarction, indicating a myocardial infarction with non-obstructive coronary arteries with an apical thrombus in the left ventricle. Following medical treatment, the patient experienced resolution of chest pain and improvement in ST-segment elevation.ConclusionsIn young female patients without traditional risk factors, human immunodeficiency virus infection is a possible etiological factor for myocardial infarction with non-obstructive coronary arteries. The likely pathophysiological pathway is superficial endothelial cell denudation as a result of chronic inflammation and immune activation.

Exploring the Relationship between Acute Coronary Syndrome, Lower Respiratory Tract Infections, and Atmospheric Pollution.

Background: Respiratory infections were found to be connected with the incidence of acute coronary syndrome (ACS). The proposed pathway of this connection includes inflammation, oxidative stress, pro-coagulation, and atherosclerotic plaque destabilization. This can cause rapture and thrombus formation, leading to ACS. Our study aimed to assess the risk factors for coronary artery thrombosis as a manifestation of ACS and for lower respiratory tract infections (LRTIs) in patients with ACS. Methods: The study included 876 patients with ACS from January 2014 to December 2018. Both the clinical data and air pollution data were analyzed. Statistical tests used for analysis included Student's t-test, the Mann-Whitney U-test, the Chi-squared test, and the odds ratio Altman calculation. Results: LRTIs were found in 9.13% patients with ACS. The patients with LRTI had a higher risk of coronary artery thrombosis (OR: 2.4903; CI: 1.3483 to 4.5996). Moreover, they had increased values of inflammatory markers, were older, had a lower BMI, and a higher rate of atrial fibrillation. The average atmospheric aerosols with a maximum diameter of 2.5 μm (PM2.5 concentration) from three consecutive days before hospitalization for ACS were higher in patients with LRTI. Conclusions: The occurrence of coronary artery thrombosis was higher among the patients with LRTI during ACS. PM2.5 exposition was higher in the three consecutive days before hospitalization in patients with LRTI during ACS.

Anticipated prehospital decision delay in response to different symptom clusters in acute coronary syndrome: Results from the Spanish Cardiobarometer study

Background and objectiveReducing patient decision delay – the time elapsed between symptom onset and the moment the patient decides to seek medical attention – can help improve acute coronary syndrome survival. Patient decision delay is typically investigated in retrospective studies of acute coronary syndrome survivors that are prone to several biases. To offer an alternative approach, the goal of this research was to investigate anticipated patient decision delay in the general population in response to different symptom clusters. MethodsWe developed scenarios representing four commonly experienced symptom clusters: classic (chest symptoms only), heavy (a large number of very intense symptoms including chest pain), diffuse (mild symptoms including chest pain), and weary (mild symptoms without clear chest involvement). The scenarios were administered in random order in a representative survey of 1002 adults ≥55 years old from the non-institutionalized general population in Spain. We measured help-seeking intentions, anticipated patient decision delay (waiting >30 min to seek help), and symptom attribution. ResultsPatient decision delay was most common in the diffuse scenario (55%), followed by the weary (34%), classic (22%), and heavy (11%) scenarios. Attributing the symptoms to a cardiovascular cause and intentions to call emergency services were least frequent in the weary and diffuse scenarios. Women were less likely to intend to seek help than men in the classic (OR = 0.48, [0.27, 0.85], diffuse (OR = 0.67, [0.48, 0.92]), and weary (OR = 0.66, [0.44, 0.98]) scenarios, despite being more likely to attribute symptoms to cardiovascular causes. Participants with traditional cardiovascular risk factors (e.g., diabetes, hypercholesterolemia, hypertension) reported faster help-seeking, whereas participants with obesity and history of depression were more likely to delay. DiscussionThe diverse manifestations of acute coronary syndrome generate fundamentally different appraisals. Anticipated patient decision delay varies as a function of socio-demographic characteristics and medical history, supporting findings from studies with patients who experienced ACS. Measuring anticipated patient decision delay in the general population can help reveal potential barriers to help-seeking and capture effects of population interventions.

Comparison of the Clinical Manifestations of Acute Coronary Syndrome Between Diabetic and Non-diabetic Patients: A Systematic Review and Meta-Analysis.

The presentation of acute coronary syndrome (ACS) in patients with type 2 diabetes mellitus (T2DM) may differ from that of non-diabetic patients, potentially leading to delayed diagnosis and treatment. This meta-analysis aimed to compare the clinical presentation of ACS between diabetic and non-diabetic patients. A systematic search of PubMed, Excerpta Medica database (EMBASE), and Web of Science databases was conducted for observational studies published from January 2010 onwards. Studies comparing ACS symptoms between diabetic and non-diabetic patients were included. The odds ratio (OR) with 95% confidence intervals (CI) was calculated using a random-effects model. Eight studies with a total of 29,503 patients (23.03% diabetic) were included. Diabetic patients were significantly less likely to present with chest pain compared to non-diabetic patients (OR: 0.43, 95% CI: 0.30 to 0.63, p<0.001). Anxiety (OR: 2.20, 95% CI: 1.17-4.14), shortness of breath (OR: 1.49, 95% CI: 1.11-2.01), and neck pain (OR: 1.62, 95% CI: 1.03-2.54) were significantly more common in diabetic patients. Sweating/cold sweat was less common in diabetics (OR: 0.60, 95% CI: 0.34-1.07), though not statistically significant. Other symptoms showed minimal differences between groups. High heterogeneity was observed across studies for most symptoms. This meta-analysis demonstrates that diabetic patients with ACS are less likely to experience typical chest pain and more likely to present with atypical symptoms such as anxiety, shortness of breath, and neck pain. These findings emphasize the need for healthcare providers to maintain high vigilance for atypical ACS presentations in diabetic patients. Tailored diagnostic approaches, modified triage protocols, and enhanced patient education are crucial to improving the timely diagnosis and treatment of ACS in this high-risk population.

Evolving Concepts of the SCORE System: Subtracting Cholesterol from Risk Estimation: A Way for a Healthy Longevity?

The role of cholesterol, mainly low-density lipoproteins (LDL-C), as a causal risk factor for atherosclerotic cardiovascular disease (ASCVD) is now established and accepted by the international scientific community. Based on this evidence, the European and American guidelines recommend early risk stratification and "rapid" achievement of the suggested target according to the risk estimation to reduce the number of major cardiovascular events. Prolonged exposure over the years to high levels of LDL-C is one of the determining factors in the development and progression of atherosclerotic plaque, on which the action of conventional risk factors (cigarette smoking, excess weight, sedentary lifestyle, arterial hypertension, diabetes mellitus) as well as non-conventional risk factors (gut microbiota, hyperuricemia, inflammation), alone or in combination, favors the destabilization of the atherosclerotic lesion with rupture/fissuration/ulceration and consequent formation of intravascular thrombosis, which leads to the acute clinical manifestations of acute coronary syndromes. In the current clinical practice, there is a growing number of cases that, although extremely common, are emblematic of the concept of long-term exposure to the risk factor (LDL hypercholesterolemia), which, not adequately controlled and in combination with other risk factors, has favored the onset of major cardiovascular events. The triple concept of "go lower, start earlier and keep longer!" should be applied in current clinical practice at any level of prevention. In the present manuscript, we will review the current evidence and documents supporting the causal role of LDL-C in determining ASCVD and whether it is time to remove it from any score.

WELLENS SYNDROME: TIMELY RECOGNITION AND SUCCESSFUL REVASCULARIZATION

Abstract Wellens syndrome is a condition characterized by clinical and instrumental signs suggestive of a critical proximal left anterior descending (LAD) coronary artery stenosis and requires early revascularization. Diagnostic criteria include T–wave changes in ECG during asymptomatic periods in patients with a history of chest pain, absence of significant cardiac enzyme movement, no ST–segment elevation, preserved R–wave, and no pathological Q waves. Early recognition of this syndrome is crucial, due to its 10–15% prevalence, allowing proper management and myocardial function recovery, avoiding potentially catastrophic outcomes. A 64–year–old male, with hypertension, undiagnosed diabetes, and family history of CAD, presented to our ER with sudden, brief chest pain radiating to the left upper limb. Similar episodes had occurred in the past week. The patient denied previous cardiovascular events and home therapy. ECG conducted by the attending cardiologist, during free chest pain period, showed biphasic T–wave in V1–V3 (a). Admission ECG resembled the ambulatory one. Lab results: Hb 14.7 g/dl, Troponin I 0.059 ng/ml (cut–off 0.034). Echocardiogram indicated distal septum akinesia. Urgent coronary angiography was performed, detecting subocclusive stenosis in the proximal–mid LAD. Successful revascularization was achieved by PTCA and implantation of 1 DES. (b) Subsequently, the patient was admitted to the Cardiac Intensive Care Unit for multiparametric monitoring. The ECG showed deeply negative T waves from V1 to V6. (c) No complications during hospitalization. Discharge ECG showed repolarization anomalies improvement. Echocardiography revealed preserved systolic function, without global or segmental anomalies in wall motion. Wellens syndrome is a manifestation of acute coronary syndrome that precedes an anterior wall MI. This condition can be identified by its characteristic T–wave patterns on ECG. Patients with this syndrome have severe LAD occlusion and require early coronary intervention. In chest pain episodes, the ECG appears normal, and troponin levels often remain within the normal range, which can potentially provide false reassurance. Wellens syndrome is a cardiac emergency requiring immediate attention; it is crucial for the physician to promptly identify the typical ECG signs of Wellens Syndrome, facilitating early coronary revascularization to prevent adverse patient outcomes.

Correlation of Plasmatic Amyloid Beta Peptides (Aβ-40, Aβ-42) with Myocardial Injury and Inflammatory Biomarkers in Acute Coronary Syndrome.

Background/Objective: Amyloid beta (β) -40 levels increase with age and inflammation states and appear to be associated with clinical manifestations of acute coronary syndrome (ACS). We investigated the correlation of Aβ peptides with myocardial injury and inflammation biomarkers in patients with or without ST elevation myocardial infarction (STEMI, NSTEMI). Methods: This singe-center, cross-sectional, observational, and correlation study included 65 patients with ACS (n = 34 STEMI, 29 males, age = 58 ± 12 years; n = 31 NSTEMI, 22 males, age = 60 ± 12 years) who were enrolled in the coronary care unit within 12 h after symptom onset from February 2022 to May 2023. Aβ peptide levels and biochemical parameters were assessed. Results: NSTEMI patients had a higher prevalence of hypertension (p = 0.039), diabetes (p = 0.043), smoking (p = 0.003), and prior myocardial infarction (p = 0.010) compared to STEMI patients. We observed a higher level of Aβ-42 in NSTEMI (p = 0.001) but no difference in Aβ-40 levels. We also found a correlation between age and NT-proBNP with both Aβ peptides (Aβ-40, Aβ-42) (p = 0.001, p = 0.002 respectively). Conclusions: Our results show that patients with NSTEMI had a higher prevalence of cardiovascular risk factors (hypertension, diabetes, smoking, and prior myocardial infarction). Considering these results, we propose that Aβ-42 can add value to risk stratification in NSTEMI patients.

Design of an iterative method for enhanced early prediction of acute coronary syndrome using XAI analysis

&lt;p&gt;The escalating prevalence and acute manifestations of Acute Coronary Syndrome (ACS) necessitate advanced early detection mechanisms. Traditional methodologies exhibit limitations in predictive accuracy, sensitivity, and timeliness, thus hindering effective intervention and patient care management. This study introduces a comprehensive machine learning-based approach to surmount these constraints, thereby enhancing early ACS prediction capabilities for different scenarios. Addressing data integrity, the methodology encompasses rigorous data preprocessing techniques, including advanced missing value imputation and outlier detection, to ensure dataset reliability. Feature selection is meticulously conducted through a recursive feature elimination and correlation analysis, thereby distilling critical predictive indicators from extensive clinical datasets. The study harnesses diverse algorithms—Support Vector Machines, Logistic Regression, Gradient Boosting Machines, and Deep Forest—tailored for nuanced ACS detection, balancing simplicity with computational depth to optimize performance metrics. The proposed model exhibits a superior predictive proficiency, as evidenced by significant improvements in precision, accuracy, recall, and reduced prediction delay compared to the existing approaches. The Logistic Regression coefficients and the SHapley Additive exPlanations (SHAP) values provide interpretative insights into the risk factor significance, facilitating personalized patient risk assessments. Furthermore, the study pioneers a clinically applicable risk scoring system, which is thoroughly evaluated through sensitivity, specificity, and positive predictive value metrics. Implications of this research extend beyond theoretical advancement, offering tangible enhancements in ACS predictive analytics. The enhanced model promises improved patient outcomes through timely and accurate ACS detection, thus optimizing healthcare resource allocation. Future research directions are identified, which advocate for the exploration of novel risk factors and the application of cutting-edge machine learning techniques to foster inclusivity and adaptability in diverse healthcare settings.&lt;/p&gt;

МАГНИТНО-РЕЗОНАНСНАЯ ТОМОГРАФИЯ СЕРДЦА В ДИАГНОСТИКЕ МИКСОМЫ ЛЕВОГО ПРЕДСЕРДИЯ

Abstract. Introduction. Left atrial myxoma is one of the most common benign cardiac tumors. Myxomas occur most frequently in people aged 30-60 years. This tumor is one of the most difficult to diagnose due to the different density of its structure. Aim. To present our own clinical case report on choosing the strategy of managing a patient with left atrial myxoma. Materials and Methods. Female patient N., 66 years old, was admitted to the Department of Cardiology at City Clinical Hospital 7, Kazan on a referral from the polyclinic with complaints of recurrent burning chest pain radiating to the left arm and occurring during physical exertion (walking up to 50-100 m), accompanied by dyspnea; increase in blood pressure up to 180/100 mm Hg, heart performance disorders, heart palpitations, dizziness, and high-blood- pressure-associated headaches. When writing this article, the authors used the patient’s source documents (her case history). The article details the current disease history, clinical manifestations, examination findings, and the approaches to choosing the patient management considering her age and clinical manifestations. Results and Discussion. Clinical manifestations of the disease set on in January 2023 with dyspnea occurring during accelerated walking and burning chest pain. Before her admission to City Clinical Hospital 7, heart pain syndrome had recurred. In view of the clinical manifestations of acute coronary syndrome, the patient was prescribed coronary angiography that detected multivessel coronary artery disease. Echocardiography detected congenital heart disease: Secondary atrial septal defect. Thrombus? Myxoma? in the left atrium cavity. Magnetic resonance imaging of the heart was performed to verify the diagnosis. This technique allowed us to determine her accurate diagnosis: Left atrium myxoma; atrial septal defect. Conclusions. Practitioners will need these data to choose the strategy of managing patients with left atrial myxoma

КЛИНИЧЕСКИЙ СЛУЧАЙ ДИАГНОСТИКИ КОАРКТАЦИИ АОРТЫ В ПОЖИЛОМ ВОЗРАСТЕ

Abstract. Introduction. Aortic coarctation is a congenital narrowing or complete rupture of aorta in the region of its arch, isthmus, lower thoracic part, or abdominal region. Predominantly (in over 90% of cases), the coarctation occurs in a “typical” place, i.e., around the aortic isthmus. This defect is often combined with other defects, such as bicuspid aortic valve, aortic stenosis, patent ductus arteriosus, and ventricular septal defect. Aim: To actualize knowledge about aortic coarctation and its potential clinical manifestations. Materials and Methods. Female patient N., 65 years old, was admitted in the Department of Cardiology of City Clinical Hospital 7, Kazan in an urgent manner, complaining of fatigue, chest burning that could not be reversed by taking nitroglycerin, mixed dyspnea at the minimum exercise load, heart activity disorders, and rapid uneven heartbeat for a long time. The patient was examined using general clinical, laboratory and instrumental methods. In writing this article, the authors used source medical records (history of the present disease). Results and Discussion. The defect manifested in the patient clinically at her age of 25 as her systemic hypertension was first detected, accompanied by headache, dizziness, seeing dark spots in her vision, and later rapid heartbeat and short of breath on exertion. According to literature, in about 10% of cases, early development of aortic atherosclerosis is observed especially at the site of narrowing, as well as atherosclerosis of the coronary arteries, which caused unstable angina pectoris and the development of atrial fibrillation in our patient. In view of clinical manifestations of acute coronary syndrome, the patient was prescribed coronary angiography, during which aortic coarctation was suspected. Echocardiography detected congenital heart disease that often accompanies aortic coarctation (up to 60% of cases according to official sources), namely bicuspid aortic valve, as well as atrial septal aneurysm, reduction of descending aorta, and moderate aortic stenosis with aortic insufficiency. Further, to verify the diagnosis, X-ray computed tomography of the aorta was performed, which is the gold standard in detecting aortic coarctation. This method allowed us to identify the extent of the lesion, the diameter of the narrowing of the aorta, pre- and post-stenotic areas, and the presence and condition of collaterals. Conclusions. These findings are necessary for practicing physicians when choosing a treatment strategy for patients with aortic coarctation.

НЕ ИШЕМИЧЕСКИЕ ФЕНОТИПЫ ПАЦИЕНТОВ С ОСТРОЙ БОЛЬЮ В ГРУДИ ПО ДАННЫМ СТРЕСС-ЭХОКАРДИОГРАФИИ С ФИЗИЧЕСКОЙ НАГРУЗКОЙ

INTRODUCTION Acute chest pain is one of the most common caus­es for emergency medical care seeking. In some cases, it is considered as a manifestation of acute coronary syndrome (ACS). However, in patients with normal cardiac troponin (cTn) levels and a normal or non­diagnostic electrocardiogram (ECG) (non-ST eleva­tion ACS (NSTE-ACS) low-risk patients), the inci­dence of stenotic coronary atherosclerosis is not high. Stress echocardiography in this category of patients is indicated for ischemia visualization. Analysis of heart rhythm, ECG changes, systemic and intra­cardiac hemodynamics, in addition to assessing lo­cal contractility, allows us to identify other patholog­ical responses to stress. It is already known that their comprehensive assessment has predictive potential for long-term adverse events in patients with chron­ic coronary syndrome. THE AIM To identify non-ischemic phenotypes in low-risk patients with non-ST elevation acute coronary syn­drome. MATERIAL AND METHODS A single-center, prospective, continuous study included 70 patients aged 54 (45; 63) years (60% men) hospitalized in the department of the region­al vascular center in 2022—2023 with acute chest pain, normal or non-diagnostic ECG, normal cTn level, low (&lt; 3 %) GRACE risk and no restrictions for exercise stress echocardiography. The patients had not previously verified coronary heart disease (which was an inclusion criterion) and had no wall motion abnormality at rest. Stress echocardiography on a horizontal bicycle ergometer was performed in the first 2 (0; 3) days of the hospital period. The tests were carried out in the absence of rhythm­slowing therapy. The results of tests completed ear­ly for subjective reasons (muscle fatigue, failure) were not included in further analysis. To determine patient phenotypes based on stress echocardiogra­phy data, pathological responses to stress in the form of dichotomous variables were used to perform clus­ter analysis. The final group consisted of 50 of a non­ischemic phenotype — those who did not belong to the cluster, which was characterized by the high­est frequencies of wall motion abnormality, ST seg­ment depression &gt; 1 mm, and angina. To determine the potential significance of the identified pheno­types, the cardiac performance reserve (P/m) was ad­ditionally determined as the difference in P/m val­ues, calculated using the formula 0,222 - CO - APBmean LVM where CO — cardiac output; APBmean — mean arterial blood pressure; LVM — left ventricular mass), at peak load and at rest. RESULTS Four patient phenotypes were identified that dif­fered statistically significantly (p &lt; 0.05) in terms of exercise tolerance, volumetric contractile reserve and heart rate reserve. Type 1 (n = 17) was character­ized by a high frequency of combined decreases in all 3 indicators; type 2 (n = 11) — by the decreased ex­ercise tolerance and heart rate reserve, normal con­tractile reserve; type 3 (n = 11) — by normal exercise tolerance and heart rate reserve, but decreased con­tractile reserve; type 4 (n = 11) — by normal exer­cise tolerance, contractile reserve and heart rate re­serve. The decrease in contractile reserve (types 1 and 3) was consistent with a statistically significant lower increase in left ventricular ejection fraction at peak exercise (5 (2; 7) vs. 12 (8; 13), respective­ly; p &lt; 0.001) and P/m reserve (1.0 (0.6; 1.4) versus 1.3 (1.1; 1.6), respectively; p = 0.010). Patients with decreased contractile reserve were statistically signif­ icantly older (60 (48; 68) vs. 47 (43; 54) years, re­spectively; p = 0.003). Type 4 included predominant­ly men (91 %). For type 2, no statistically significant differences in the clinical and demographic data of pa­tients were identified. CONCLUSION In the structure of patients with low-risk pa­tients with NSTE-ACS, the phenotypes are identi­fied that are determined by a decrease in exercise tol­erance, contractile deficiency and chronotropic re­serve. Phenotypes are characterized by different levels of P/m reserve and may differ in the frequency of ad­verse events in the long-term period, and a decrease in contractile and heart rate reserve can be considered as potential targets for personalized therapy, however, in the diagnostic algorithm for ACS this remains a top­ic for further research.

Cardiovascular risk factors, clinical manifestations and management of myocardial infarction in elderly and long­living patients depending on geriatric status

Aim. To study cardiovascular risk factors, clinical manifestations and management of myocardial infarction (MI) in elderly and long­living patients depending on geriatric status.Material and methods. Out of 92 patients with MI (mean age, 81,6±4,2), 3 following groups were formed: "frailty" — 35 (38,0%), "prefrailty" — 16 (17,4%), and "no frailty" — 41 (44,6%). The following questionnaires were used: Age Is Not a Hindrance, Mini Nutritional Assessment (MNA), Barthel Index for Activities of Daily Living, Lawton Instrumental Activities of Daily Living Scale, balance test, Gait Speed Test, Timed Up and Go test, grip test, Mini Mental State Examination (MMSE), Clock Drawing Test, Geriatric Depression Scale.Results. Frailty probability in patients is higher in the presence of obesity, type 2 diabetes, a decrease in glomerular filtration rate (GFR) &lt;60 ml/min/1,73 m2, a stroke, and heart failure. In the event of clinical manifestations of acute coronary syndrome (ACS), patients without frailty sought medical assistance earlier (in the first 2 hours — 26,8% of patients (χ2=7,8, p=0,005). Most patients with prefrailty and frailty called an ambulance later, but in the first 12 hours — 68,8 and 74,3%, respectively (χ2=15,6, p=0,012). The prevalence of thrombolysis is 23,2%, percutaneous coronary intervention — 30,4% and did not depend on geriatric status. The probability of multivessel disease is higher in patients with or at risk of malnutrition. The main hemodynamic parameters, echocardiography, laboratory parameters in patients with MI did not depend on geriatric status. According to the STOPP/START criteria, frail patients with more often received nonrecommended inhospital medicines.Conclusion. Frailty in patients with MI was associated with multiple cardiovascular risk factors, later medical assistance, and more frequent non-recommended treatment.

Okluzija u dominantnom levom koronarnom sistemu - EKG dilema u radu lekara hitne pomoći

Introduction/Objective Acute chest pain is the main clinical manifestation of acute coronary syndrome. A posterior myocardial infarction (MI) most commonly occurs as a complication or extension of an inferior MI because of the overlapping coronary vascularization. We are presenting a case in which the patient exhibited mild anginal symptoms and an ECG pattern which did not correlate with a devastating infarction. Case report: The Emergency Medical Team (EMT) was dispatched at 5 am to help a 62-year-old patient, who had been woken from his sleep by a feeling of tightness in his chest and weakness in both arms. Upon examination, the patient was hypertensive (160/90 mmHg) and moderately bradycardic (58-62/min), with normal oxygen saturation on room air (SaO2 98%). His prehospital ECG findings were as follows: sinus rhythm, horizontal ST depression in V1-V3 1 to 2mm, ST elevation ≤1mm in lead V6, subtle ST depression in D1 and aVL &lt;1mm, ST elevation in D3 and aVF &lt;1mm. After attaching additional posterior leads, the modified ECG recording showed an ST elevation of 1 to 2 mm in V7-V9. Continuous laboratory monitoring of cardiac enzyme markers showed elevated and increasing values: Troponin T -2377, 3756 ng/l; CK -1572, 1564 U/l. Coronary angiography: The LCA system was dominant. The RCA was nondominant with a 70-80% stenosis, and a complete Occlusion Myocardial Infarction (OMI) distally. Using the most accurate LCxc/RCA occlusion algorithms, the ECG finding suggested an occlusion in the right dominant coronary system, which does not correlate with the coronary angiography report. Conclusion: Excellent knowledge of recording, analysis, and interpretation of ECG tracings, facilitates adequate pre-hospital care and precise planning for further processing of patients with chest pain. It is recommended to record posterior and right unipolar leads in all patients with inferior and suspicion of posterior myocardial infarctions and to include the ST-elevation myocardial infarction equivalent into the STEMI network. Given the physiological differences in left ventricular vascularization and the possible predominance of the left coronary system over the right, future studies must focus on establishing more precise algorithms for assessing RCA/LCx occlusion.

Impact of admitting department on the management of acute coronary syndrome after an out of hospital cardiac arrest.

This study aimed to analyze the influence of the hospital admitting department on adherence to the Guidelines of European Society of Cardiology for management of acute coronary syndromes in patients after out-of-hospital cardiac arrest (OHCA) of coronary etiology. We studied retrospective-prospective register of 102 consecutive patients with OHCA as a manifestation of acute coronary syndrome (ACS). Patients were admitted to the coronary care unit (CCU) 52, general intensive care unit (GICU) 21, or GICU after initial Cath lab treatment (CAG-GICU) 29. This study compared the differences in the management of ACS in patients with OHCA of coronary etiology based on the admitting department in a tertiary care institution. Twelve of the 21 (57.1%) patients admitted to the GICU were evaluated as having ACS on-site where they experienced OHCA. In the CCU group, 50 out of 52 (96.2%) and 28 of 29 (100%) patients in the CAG-GICU group (P<0.001). Coronary angiography was performed in 10 of 21 patients (48%) admitted to the GICU. It was performed in 49 out of 52 (94%) CCU patients and, in the CAG-GICU group, 28 out of 29 patients. The mean time to CAG differed significantly across groups (that is, GICU 200.7 min., CCU 71.2 min., and CAG-GICU 7.5 min. (P<0.001)). Aspirin was used in 48% of GICU, 96% of CCU, and 79% of CAG-GICU patients (P<0.001), while in the pre-hospital phase, aspirin was used in 9.5% of GICU, 71.2% of CCU, and 50% of CAG-GICU patients (P<0.001). P2Y12 inhibitor prescriptions were lower in patients admitted to the GICU (33% vs. 89% CCU and 57% CAG-GICU, P<0.001). The department's choice significantly affected the time to initiation of antithrombotics, which was the longest in the GICU. The choice of admission department for patients with OHCA caused by ACS was found to affect the extent to which the recommended treatments were used. An examination of OHCA patients by a cardiologist upon admission to the hospital increased the likelihood of an early diagnosis of ACS as the cause of OHCA.

Long-Term Effects on the Lipidome of Acute Coronary Syndrome Patients.

Lipids modified by oxidative stress are key players in atherosclerosis progression. Superimposed thrombosis with subsequent closure of the coronary artery leads to the clinical manifestation of acute coronary syndrome (ACS). While several studies focusing on alterations in lipid metabolism in the acute phase have been conducted, no information is available on patients’ lipidome alterations over longer time periods. In the current follow-up study, we analyzed plasma samples obtained from 17 patients three years after their ACS event (group AC). Originally, these patients were sampled 3–5 days after an index event (group B). Lipidome stability over time was studied by untargeted lipidomics using high performance liquid chromatography coupled to high resolution mass spectrometry (UHPLC–HRMS). Multi-dimensional statistics used for data processing indicated that plasmalogen lipids were the most prominent lipids separating the above patient groups and that they increased in the follow-up AC group. A similar trend was observed for lysophosphatidylethanolamine (LPE) and phosphatidylethanolamine (PE). The opposite trend was observed for two fatty acyls of hydroxy fatty acid (FAHFAs) lipids and free stearic acid. In addition, a decrease in the “classic” oxitadive stress marker, malondialdehyde (MDA), occurred during the follow-up period. Our findings present unique information about long-term lipidome changes in patients after ACS.

Atypical manifestations of acute coronary syndrome — throat discomfort: a multi-center observational study

To present the clinical characteristics and the misdiagnosis rate of acute coronary syndrome manifested primarily as throat discomfort, we conducted a multicentric and retrospective study in the cardiology and otorhinolaryngology departments. Records of patients with primary complaint of throat discomfort, absence of chest pain at onset, and an ultimate diagnosis of acute coronary syndrome, as well as patients with pharyngitis (as controls) were collected from May 2015 to April 2016. The patients' main manifestations were compared. Logistic regression results showed that chest tightness, dyspnea, perspiring, and exertional throat symptoms were significantly associated with acute coronary syndrome, with odds ratios of 8.3 (95% CI 2.2-31.5), 10.9 (95% CI 1.8-66.9), 25.4 (95% CI 3.6-179.9), and 81.2 (95% CI 13.0-506.7). A total of 25 (56.82%) out of 44 acute coronary syndrome patients, who were first admitted to the otorhinolaryngology department, were misdiagnosed, with a 12% (3/25) mortality rate. Throat discomfort can be the principal manifestation of acute coronary syndrome. Such patients exhibit high misdiagnosis and mortality rates. Exertional throat symptoms, chest tightness, perspiring, and dyspnea were important indicators of acute coronary syndrome in patients whose main complaint was throat discomfort. The awareness of this condition will result in prompt diagnosis and reduce morbidity and mortality.

Changing in the profile of a patient with acute coronary syndrome without ST-segment elevation over the years 2015-2020

The article represents an analysis of the dynamics of the main demographic, clinical, laboratory, and instrumental investigations, final diagnoses of patients who were hospitalized with a diagnosis of acute coronary syndrome without ST segment elevation. A distinctive feature of the work is the recruitment of patients in the same medical institution for different periods of time, which makes possible to trace the dynamics of the clinical profile of patients in the population of Dnipro, a large industrial center of Ukraine. The prevalence of arterial hypertension, chronic heart failure and previous myocardial infarction remained at the same level. In the 2017-2020’s group compared with the 2015’s group, electrocardiographic manifestations of acute coronary syndrome without ST-segment elevation upon admission were more often detected. Laboratory indicators such as hemoglobin, creatinine and total cholesterol levels remained the same. Another interesting finding is a statistically significant decrease in the number of patients with a reduced glomerular filtration rate according to MDRD (less than 60 ml/min/1.73 m2) in the 2017-2020’s group compared to patients in 2015’s group, although the clinical course of the disease remained practically unchanged. There was a trend towards a worsening of the clinical status and prognosis, namely, increase in the prevalence of atrial fibrillation and diabetes mellitus, increase in the risk of GRACE, as well as increase in the quantity of verified diagnoses of unstable angina, which is most likely associated with the increased use of high-sensitivity troponin. Noteworthy feature is that increase in the quantity of high-risk patients led to an increase in the mean GRACE score.

Comparative characteristics of the state of the immune system in patients with coronary artery disease with stable angina pectoris and acute coronary syndrome

The aim – to assess the relationship between the state of the immune system and the development of acute coronary syndrome in patients with IHD.Materials and methods. The first group consisted of 64 patients with ST-segment elevation acute coronary syndrome, mean age 54 (49–64) years; the second group – 223 patients with coronary artery disease with stable exertional angina, FC II–III, mean age 56 (49–63) years; the third group – 47 patients with acute coronary syndrome without ST segment elevation, mean age 61 (52–65) years. The material for the immunological study was peripheral venous blood. To determine the parameters of cellular and humoral innate and adaptive immunity in blood serum and supernatants of mononuclear cells, enzyme immunoassay was used.Results and discussion. In patients with coronary artery disease with acute coronary syndrome with ST segment elevation compared with patients with coronary artery disease with stable angina pectoris, the levels of indicators of the immune status in the blood were: CRP – 9.3 (5.3–12.0) versus 4.8 (2.4–8.1) mg/L (p=0.0001), sICAM – 785 (690–830) versus 565 (406–744) ng/ml (p=0.0001), IL-10 in blood mononuclear cells – 48 (1–228) versus 194 (21–758) pg/ml (p=0.0007), circulating immune complexes – 90 (70–108) versus 76 (54–105) od. (p=0.045), lymphocytes with apoptosis (CD95) – 16 (9–27) versus 11 (8–17) % (p=0.029), spontaneous oxygen-dependent metabolism of monocytes – 16 (12–21) versus 13 (9–17) (p=0.001). The levels of indicators of the immune system in the blood in patients with coronary artery disease with acute coronary syndrome with ST segment elevation compared with patients with coronary artery disease with acute coronary syndrome without ST segment elevation were: T-helpers – 37 (32–41) versus 42 (37–48) % (p=0.0006) (R=–0.33; p=0.0005), reaction of lymphocyte blast transformation to nonspecific antigen – 38 (32–47) versus 50 (42–61) % (p=0.0004) (R=–0.37; p=0.0003).Conclusions. The development of acute coronary syndrome is directly combined with increased activity of the immune system, as evidenced by the high production of proinflammatory CRP, IL-8, sICAM with a low level of anti-inflammatory IL-10, a pronounced humoral adaptive immune response (in terms of antibodies to the myocardium and vascular tissues, CD40, circulating immune complexes) and active functional state of monocytes (according to cNCT test, functional reserve, phagocytosis) in patients with coronary artery disease with acute coronary syndrome, regardless of the position of the ST segment in comparison with patients with stable coronary artery disease. Elevated levels of antibodies to the myocardium in patients with stable coronary heart disease indicate moderate myocardial damage due to temporary ischemia in angina attacks, even with a stable course of the disease. In patients with acute coronary syndrome, high levels of antibodies to the myocardium indicate myocardial damage due to increased ischemia in plaque destabilization much earlier than the clinical manifestations of acute coronary syndrome. In acute coronary syndrome with ST-segment elevation, compared with ACS patients without ST-segment elevation, activation of neutrophils and suppression of the activity of adaptive T-cell immunity is noted (by the level of T-helpers, sCD40L, blast transformation of lymphocytes, γ-interferon in mononuclear cells, apoptosis of lymphocytes).

Manifestation of Acute Coronary Syndrome in Critically Aortic Stenosis Patients

The clinical presentation of acute coronary syndromes (ACS) is broad, from cardiac arrest, electrical or haemodynamic instability with cardiogenic shock (CS) due to ongoing ischaemia or mechanical complications such as severe mitral regurgitation, to patients who are already pain free again at the time of presentation. Critical aortic stenosis (AS) can cause inadequate myocardial perfusion and in the absence of demonstrable coronary stenosis or occlusion which resulting in ACS manifestation. Critical AS (defined as valve area &lt;0.5 cm2) has been reported to cause mild increases in cardiac biomarkers such as troponin I. A 56-year-old man was admitted to hospital with chief complaint of typcal chest pain. Electrocardiogram (ECG) shows myocardial infarction in left main (LM) equivalent. Echocardiography revealed critical aortic stenosis. Cardiac marker also shows increasing. However, diagnostic coronary angiography (DCA) did not identify any lesions to account for the patient’s electrocardiographic changes and ongoing symptoms of chest pain. Consultation to cardiothorax surgeon to have urgent aortic valve replacement (AVR) were planned and underwent successful aortic valve (AV) replacement without coronary intervention. The definitive treatment for symptomatic severe AS is AVR. Some of the treatments that can be done are immediate coronary angiography and reperfusion procedure if there is suspicion of coronary artery occlusion or stenosis which may cause myocardial infarction; Intra-Aortic Ballon Pump (IABP) if there are signs of myocardial injury with take caution to the contraindications of IABP placement; Perform intervention procedure as soon as possible on aortic valve; Administration of medical therapy for heart failure in symptomatic severe AS patients. The case emphasizes the importance of initial physical examination, ECG, echocardiography, and cardiac markers as a whole that we do in aortic valve stenosis patient presenting with ACS.

Direct myocardial revascularization after 6, 12 and 24 hours of acute coronary syndrome

To evaluate the results of direct myocardial revascularization within 72 hours after manifestation of acute coronary syndrome. A retrospective study included 48 (0.47%) out of 10 193 patients with coronary artery disease who underwent coronary artery bypass grafting for the period 2011-2019. Study patients underwent urgent direct myocardial revascularization. SYNTAX Score >22 points was observed in all cases. All patients were divided into 3 groups depending on timing of surgery: 26 patients - within 6 hours after admission, 15 patients - within 6 - 24 hours, 7 patients - within 24-72 hours. Level of myocardial damage markers was similar after 1 and 2 days (p>0.05). In the 1st group, 1 (3.84%) patient died in hospital, 5 (19.2%) patients - within 1 year after surgery. In the 2nd group, these values were 1 (6.6%) and 0, respectively. There was no mortality in the 3rd group (p>0.05). Overall 5-year survival was 100%. Early active open revascularization is advisable in patients with ACS and clear indications for surgery.