Manifestation Of Acute Myocardial Infarction Research Articles

Headache as the sole clinical manifestation of acute myocardial infarction: one case with cardiac cephalalgia and literature review.

Cardiac cephalalgia, once seen as a rare symptom of coronary artery disease, is now more recognized. It often comes with chest discomfort and autonomic dysfunction, worsened by physical activity. However, not all cases have chest symptoms or are activity induced. This report presents a case of cardiac cephalalgia and reviews 46 previous cases. We discuss a unique case where a patient had headache attacks without chest symptoms, autonomic dysfunction, or triggers. We reviewed English case reports of cardiac cephalalgia from 1982 to 2022 using PubMed (http://www.ncbi.nlm.nih.gov/pubmed). A 69-year-old man presented with a sudden headache without triggers or typical symptoms. Coronary computed tomography angiography (CTA) showed diffuse stenosis in the left anterior descending and the first diagonal branch arteries. His headache improved after percutaneous coronary intervention. Cardiac cephalalgia is usually marked by severe headaches, autonomic signs, and often affects the occipital region. Electrocardiogram (ECG) might not always show abnormalities, and chest pain is not always present. In such cases, elevated cardiac enzymes can be crucial for diagnosis. When a headache is the sole symptom of an acute coronary event, consider moderate to severe intensity, older age at onset, occipital localization, and autonomic signs. ECG, cardiac enzymes, and coronary CTA are valuable for accurate diagnosis and treatment.

Risk factors, Clinical presentation and In-hospital Outcome of Acute Myocardial Infarction in Elderly Patients

Background: Coronary artery disease (CAD) is the leading cause of mortality, morbidity in the developed and developing country. Ageing is important risk factor for coronary artery disease. The role of conventional cardiovascular risk factors in older persons is incompletely understood because only fragmentary and inadequate data are available in most instance and manifestations of acute myocardial infarction are generally believed to be atypical in the elderly. The aim of the study was to find out the clinical presentation, common risk factors and In-hospital Outcome of Acute Myocardial Infarction in Elderly Patients. Methods: An observational study in tertiary level hospital. Study protocol was approved by ethical review committee of Sir Salimullah Medical College & Mitford Hospital, Dhaka. Sample was selected from the population by purposive sampling technique. Detail demographic data were collected from the subject and recorded in structured case report form. Researcher makes contact with patient and patients caregiver, and describe them about study aim-objective, and then informed consent was taken. All collected questionnaire checked very carefully to identify the error in the data. Data processing work were consisting of registration of schedules, editing, coding and computerization, preparation of dummy tables, analysis and matching data. Result: In this series, the maximum number of patients (57.0%) was between 60-69 years age group, with mean value 67.21 ± 9.05 years. Out of 100 cases (62%) cases were male and (38%) were female (Figure 1). Male – female ratio was 1.63:1. Large numbers of respondents came from urban area (58%). Among the patients the poor class (44%) comprising the major percentage of the myocardial infarction patients. In this study majority (58%) of the patients had sedentary lifestyle before the onset of myocardial infarction. Among all the risk factors hypertension was the most common risk factor, present in 62% cases; next common risk factors were Diabetes mellitus 56%, dyslipidemia 32%, obesity 22%, smoking 40%. In this study majority of patients (56%) presented with shortness of breath as predominant symptoms. Besides typical chest pain others important atypical symptoms were atypical chest pain (31%), upper abdominal pain (18%), giddiness (4%) and confusional state (3%). In this study many of the patients had developed acute LVF (34%), arrhythmia (17%), cardiogenic shock (8%). Conclusion: We concluded that the manifestations of AMI are more subtle in the elderly, with different risk factors. The elderly subjects are under thrombolysed and have higher complication rate. Bangladesh J Medicine 2024; 35(1): 9-14

Clinical Manifestation of Acute Myocardial Infarction in Elderly Patients

Myocardial Infarction is one of the most common causes of mortality and morbidity among the elderly patients. Also, it is known for wide range of clinical presentations other than chest pain. Yet, a large number of patients may have atypical or no symptoms. As an indication of a cardiac problem, resulting in a delay in seeking medical care the absence of typical chest pain and the vagueness of symptoms might not be recognized. The absence of typical chest pain and the vagueness of symptoms might not be recognized. This cross sectional observational study was carried out among 50 patients >60 years of either sex with acute myocardial infarction in the Department of Medicine and CCU of Dhaka Medical College Hospital, Dhaka, from January 2018 to July 2018. Then consent was taken. History taking and physical examination were done in a predesigned data collection sheet. Then required investigation like ECG, cardiac enzymes and relevant laboratory investigations was done. After collecting all available information statistical analysis was done using SPSS for windows version 20. Result was expressed as frequency, percentage, mean (±SD), range, p-value. Among the 50 patients diagnosed as having AMI, 14 (28%) patients presented with atypical presentation to the hospital. Atypically presenting AMI Patients were mostly ae group 60-69 years (50%). Among all patients 29 (58%) were male and 21(42%) were female. 14 (28%) patients had no complaints of chest pain, out of which, dyspnea and epigastric pain (28.6%) are the commonest. Atypical presentation is found in 38.1% of female elderly patients and 20.7% of male patients (p=0.002). Commonest risk factor, found in this study was hypertension (66%) of the patients included in the study. Next common was Diabetes Mellitus (64%), hypercholesterolemia (56%) and smoking (28%). 13 Patients with Diabetes presented with atypical symptoms among atypical group (p=0.008). Most of the patients with atypical symptoms (78%) presented lately more than 12 hours compared to patients with typical symptom. Mortality rate was higher among the patient presented with atypical symptoms (42.3%) than among the patients presented with typical chest pain (27.7%). 28% patient with atypical chest pain was found to have inferior MI and mortality was highest among those with inferior MI and atypical symptoms. This study showed that even though chest pain was the most common presentation in elderly AMI patients, they were also found to have atypical presentations like dyspnea, vomiting, sweating and epigastric pain. This signifies the need of examining physicians to meticulously identify acute myocardial infarction in elderly for successful and immediate treatment. Accurate diagnosis of ACS could reduce hospital mortality and morbidity. Bangladesh Med J. 2022 May; 51(2): 13-20

Increased Vulnerability and Distinct Layered Phenotype at Culprit and Nonculprit Lesions in STEMI Versus NSTEMI

ObjectivesThis study aimed to investigate the pancoronary plaque vulnerability (including culprit and nonculprit lesions) and layered phenotype in patients with ST-segment elevation myocardial infarction (STEMI) vs non-STEMI (NSTEMI). BackgroundPancoronary vulnerability should account for distinct clinical manifestations of acute myocardial infarction (AMI). Layered plaque is indicative of previous coronary destabilization and thrombosis. MethodsA total of 464 patients with AMI who underwent 3-vessel optical coherence tomography imaging were consecutively studied and divided into a STEMI group (318 patients; 318 culprit and 1,187 nonculprit plaques) and a NSTEMI group (146 patients; 146 culprit and 560 nonculprit plaques). Patients were followed up for a median period of 2 years. ResultsCompared with NSTEMI, culprit lesions in STEMI had more plaque rupture, thrombus, thin-cap fibroatheroma (TCFA), calcification, macrophage accumulation, and microvessels. The prevalence of plaque rupture (8.2% vs 4.8%; P = 0.018), microvessels (57.5% vs 45.2%; P < 0.001), and calcification (40.7% vs 30.2%; P = 0.003) at nonculprit lesions was higher in STEMI than NSTEMI. The layer area and thickness at the culprit and nonculprit lesions were significantly larger in STEMI than in NSTEMI. Multivariate analyses showed that culprit layer area (odds ratio: 1.443; 95% CI: 1.138-1.830; P = 0.002) was predictive of STEMI (vs NSTEMI), in addition to culprit TCFA, culprit thrombus, and non–left circumflex artery location of the culprit lesion. Although the type of AMI was not related to clinical outcomes, high-sensitivity C-reactive protein, culprit calcified nodule, and nonculprit TCFA predicted the 2-year major adverse cardiovascular events in patients with AMI. ConclusionsPatients with STEMI had increased plaque vulnerability (ie, more plaque rupture and microvessels) and distinct layered phenotype at the culprit and nonculprit lesions compared with patients with NSTEMI. Culprit lesion features of large layer area, TCFA, thrombus, and non–left circumflex artery location predicted the clinical presentation of STEMI.

Coronary Artery Disease among Patients Younger than 35 Years of Age

Background: Coronary artery disease (CAD) and its major manifestation of acute myocardial infarction (MI) are considered as the most common causes of morbidity and mortality worldwide. MI in very young group of age is a significant issue to focus on, however there is a scarcity of data on premature coronary heart diseases-acute MI (AMI) in this group of age. This may underestimate the important difference that exists between young and old groups of age. Objective: The main aim of this study is to evaluate the most common risk factors, including hyperlipidemia, smoking, diabetes mellitus (DM), hypertension, and positive family history of AMI with their angiographic profile, among Iraqi patients of &lt;35 years old. Materials and Methods: This study was enrolled in Surgical Specialty Hospital-Cardiac Center, Erbil, Iraq among 100 consecutive patients (77 males and 23 females) between November 2016 and December 2017 of those whose age was ≤35 years. Results: The mean age was 31.6 ± 2.91 years with an age range of 24–35 years. The incidence of AMI was significantly higher in male patients than females. The most common risk factors were hyperlipidemia (51%), smoking (49%), family history of premature CAD (44%), hypertension (25%), and DM (22%). The most common symptom and presentation of CAD was chest pain and anterior wall myocardial infarction, 67% and 64% respectively. About 56% of all the included patients who underwent Coronary Angiography, had obstructive CAD and among this group 89.2% had single vessel disease, 5.35% had three vessel disease, 3.57% had double vessel disease and 1.78% had abnormal characteristic of coronary artery (Muscle Bridge). The most common involved artery was the left anterior descending (LAD) (36%), followed by the right coronary artery (9%). Based on the electrocardiogram findings, 42% of the patients presented with ST-segment elevation myocardial infarction. Conclusion: CAD in patients younger than 35 years occurred more in the male gender. Hyperlipidemia was the most common risk factor among all the patients' and AWMI owing to the LAD artery was the most common presentation.

Analysis of four children with anomalous origin of the left coronary artery from the right sinus with interarterial course

Objective: To investigate the clinical features and improve the diagnosis and treatment of anomalous origin of the left coronary artery from the right coronary sinus with an interarterial course (ALCA-R-IAC) between the ascending aorta and main pulmonary artery in children. Methods: A retrospective analysis of the clinical manifestation, laboratory test, radiological feature, treatment and prognosis were conducted in four female children presented with ALCA-R-IAC in Beijing Children's Hospital from November 2015 to June 2018. Results: The four girls with onset age of 7.5-14.7 years were diagnosed with ALCA-R-IAC by CT coronary angiography (CTCA). Four children presented with exercise-induced syncope and clinical manifestations of acute myocardial infarction including 3 patients with acute left heart failure, 1 cardiogenic shock and 1 cardiac arrest. Nervous system involvement was found in one patient. Troponin I increased significantly to 20.65-50.00 μg/L in the four patients. Electrocardiogram (ECG) developed signs of left main coronary artery involvement. Echocardiography revealed reduced left ventricular ejection fraction (LVEF) of 25%-45% in three children and suspected anomalous origin of the left coronary artery in one child. CTCA showed an anomalous left coronary artery originating from the right coronary sinus, which had an interarterial course between the aorta and pulmonary artery leading to a slim left main coronary trunk. Two children underwent unroofing procedure and the other two children in whom physical activities were restricted received conservative managements. During a regular follow-up period of 12-43 months, all the children survived without recurrent symptoms and had good prognosis. Conclusions: ALCA-R-IAC can present as exercise-related syncope and acute myocardial infarction, even sudden death in children and adolescents. CTCA is helpful to clarify the early diagnosis of ALCA-R-IAC. Surgical intervention is the main treatment for ALCA-R-IAC and strenuous physical activities should be avoided.

Prevalence of the most frequent risk factors in Iraqi patients with acute myocardial infarction

Background: Coronary artery disease (CAD) and its major manifestation of acute myocardial infarction (AMI) are the most common causes of mortality and disability worldwide. Objectives: The major aim of this study was to assess the prevalence of the most frequent risk factors for AMI in Iraqi patients, including hypertension, hyperlipidemia, diabetes mellitus, smoking, family history, insufficient physical activity, obesity, and abnormal coronary artery characteristics. Materials and Methods: In this study, 74 patients presented with AMI (51 males and 23 female) were enrolled. Laboratory investigations were carried out using enzymatic immunoassay technique. Results: The mean age was 55.5 ± 12.47 years, with an age range of 20–90 years. The incidence of AMI in male patients was significantly higher than that in female patients. Major findings showed that 85.1% of AMI patients were insufficiently physically active and 74.3% were hypertensive. High level of low-density lipoprotein was seen in 50% of patients, high triglycerides in 41.9%, low high-density lipoprotein in 39.2%, and high total cholesterol in 34%. Nearly 39.2% were smokers, 35.1% were obese, and 29.7% were diabetic. Interestingly, 51.4% of the AMI patients had a positive family history of CAD. The left anterior descending artery was the most common vessel involved during AMI. Conclusions: The findings of this study conclude that AMI occurs in older age and in male gender among Iraqi population, and ST-elevation MI is the main presentation. Hypertension, hyperlipidemia, and smoking are the major risk factors. This study shed light on the primary prevention and control of these cardiovascular risk factors for CAD through healthy lifestyle, increased physical activity, and healthy dietary choices, which can reduce the prevalence of CAD.

Comparison of the Clinical Manifestations of Acute Myocardial Infarction in Elderly and Non-elderly Patients Admitted to the Coronary Care Unit of Ayatollah Mousavi Hospital of Zanjan

Comparison of the Clinical Manifestations of Acute Myocardial Infarction in Elderly and Non-elderly Patients Admitted to the Coronary Care Unit of Ayatollah Mousavi Hospital of Zanjan

Clinical Manifestation of Acute Myocardial Infarction: Classified by Age and Gender

Background The purpose of the study was to evaluate clinical manifestations of acute myocardial infarction as classified by age and gender.Methods This cross sectional study was conducted in a coronary care unit of a regional urban medical center in northern Iran (Amol). A total of 366 patients diagnosed with acute myocardial infarction were recruited from January to June 2013. Patient demographic information, past medical history, and current symptom data were collected.Results Multivariate logistic analyses were performed to identify risk predictors of myocardial infarction patients classified by age and gender. Risk predictors for older patients were dyspnea, OR = 1.76 (95% CI 1.01, 3.06), weakness odds ratio = 2.35 (95% CI 1.31, 4.21), nausea odds ratio = 1.83 (95% CI 1.04, 3.20), vomiting odds ratio = 2.48 (95% CI 1.34, 4.57), fatigue odds ratio=1.87 (95% CI 1.02, 3.39), belching, odds ratio = 2.13 (95% CI 1.08, 4.20), and hiccups odds ratio = 2.81 (95% CI 1.25, 6.30). Sub group analysis in older women patients identified weakness odds ratio = 3.13 (95% CI 1.11, 8.85), and belching odds ratio = 34.70 (95% CI 3.86, 312.2) as risk predictors. Among older men patients, the predominant symptoms were sweating odds ratio = 3.74 (95% CI 1.06, 13.2) and vomiting odds ratio = 2.54 (95% CI 1.10, 5.91).Conclusions This study concludes that older acute myocardial infraction patients were more likely to have non-specific symptoms. Initial assessment for acute myocardial infarction should consider the possibility of non-specific clinical manifestations, such as weakness and belching in older women, and sweating and vomiting in older men.

Окислительный стресс и гемореология у больных инфарктом миокарда с сахарным диабетом 2 типа

This paper highlights the influence of the intensity of the oxidative stress on hemorheology parameters&#x0D; in complicated and uncomplicated acute myocardial infarction in patients with diabetes type 2. The&#x0D; study was performed by analyzing the results of examination and treatment of 66 patients, men aged 65,6 ± 5,8&#x0D; years old, suffering from coronary heart disease with clinical manifestations of acute myocardial infarction and&#x0D; concomitant diabetes type 2. Depending on the presence of acute heart failure patients were divided into 2&#x0D; groups. 1st group consisted of 34 patients with myocardial infarction without complications, Group 2 - 32 patients&#x0D; who have myocardial infarction complicated by acute heart failure (II-III class classification T.Killip).&#x0D; Condition pro- and antioxidant systems were evaluated for 3 days by determining in the blood of patients&#x0D; diene conjugates, malonic dialdehyde, α-tocopherol, ceruloplasmin, calculated coefficient of oxidative stress.&#x0D; The rheological properties blood evaluated by the blood coagulation time, the hematocrit, amount the fibrinogen&#x0D; in the blood, and blood plasma viscosity, red blood cells deformability index, the aggregation of red blood cells&#x0D; and thrombocytes. The values obtained were compared with data from 32 healthy donors.&#x0D; It is revealed that the development of congestive heart failure in acute myocardial infarction in patients&#x0D; with diabetes type 2 is accompanied by activation of lipid peroxidation (LPO) by maintaining a high level of&#x0D; primary lipid peroxidation products. Insufficient activity of antioxidant defense can limit oxidative processes,&#x0D; and leads to their further growth. The damaging effect of lipid peroxidation in the cell membranes is reflected in violation of aggregation and blood viscosity indexes.

Clinical profile of acute myocardial infarction in elderly patients

ContextThe aim of study was to determine the difference in presentation, risk factors, complications, management and outcome of elderly and young patients with acute myocardial infarction (AMI). Settings and designTertiary care center; prospective observational study. Materials and methodThe study included 200 consecutive patients with AMI admitted in the ICCU, in a tertiary care center in West India. The group I consisted of 107 patients aged equal to or above 65 years and the group II consisted of 93 patients aged below 65 years. Statistical analysisTwo tailed student's t test and Chi-square statistics (Fisher's test) for P value. ResultsThe male female ratio was 1.27:1 and 3.43:1 in group I and group II respectively. Atypical presentations were more likely in the elderly, with shortness of breath as the most common presentation (40.18% versus 15.05%; P < 0.05. Risk factors like hypertension, dyslipidemia and diabetes were equally present in both groups but obesity, smoking and family history of coronary artery disease was more prevalent in younger age group (P < 0.05). The elderly were significantly less frequently revascularized (P < 0.05). Time from symptom onset to hospital admission was significantly longer in the case of elderly patients (P < 0.05). The elderly were more likely to have complications of cardiac failure (P < 0.05) and arrhythmias especially atrio-ventricular (AV) blocks. The elderly were also less likely to receive beta-blockers (P < 0.05). In-hospital mortality was higher in the elderly (P < 0.001). ConclusionWe conclude that the manifestations of AMI are more subtle in the elderly, with different risk factors.

Pseudoinfarto agudo do miocárdio devido à síndrome da disfunção ventricular apical transitória (síndrome de Takotsubo)

Takotsubo syndrome is characterized by predominantly medial-apical transient left ventricular dysfunction, which is typically triggered by physical or emotional stress. The present article reports the case of a 61-year-old female patient presenting with dizziness, excessive sweating, and sudden state of ill feeling following an episode involving intense emotional stress. The physical examination and electrocardiogram were normal upon admission, but the troponin I and creatine kinase-MB concentrations were increased. Acute myocardial infarction without ST segment elevation was suspected, and coronary angiography was immediately performed, which showed severe diffuse left ventricular hypokinesia, medial-apical systolic ballooning, and a lack of significant coronary injury. The patient was referred to the intensive care unit and was successfully treated with supportive therapy. As this case shows, Takotsubo syndrome might simulate the clinical manifestations of acute myocardial infarction, and coronary angiography is necessary to distinguish between both myocardial infarction and myocardial infarction in the acute stage. The present patient progressed with spontaneous resolution of the ventricular dysfunction without any sequelae.

Variants of Platelet Integrin αIIbβ3 Display Different Receptor Activation

Abstract 1143 Background and Objectives:Activation of αIIbβ3 is the final step leading to platelet aggregation. The polymorphism of the β3 gene of αIIbβ3 results in an amino acid exchange with a leucin (HPA-1a) or a prolin (HPA-1b) at residue 33. We have shown in patients with coronary artery disease that the HPA-1b variant of αIIbβ3 is associated with premature manifestation of acute myocardial infarction (MI) (JTH 2005). Autopsy studies have confirmed that HPA-1b is strongly associated with coronary thrombi after MI. Recently, we have documented that HPA-1b platelets display increased adhesion, increased thrombus stability, and increased outside-in signaling corresponding to their prothrombotic character. To explore the nature of this phenotype in further detail, we have now generated a model overexpressing fluorescent proteins fused with αIIbβ3 in transfected cells to assess the postulated differences between both HPA-1 isoforms with regard to αIIbβ3 activation and its concomitant conformational changes. Materials and Methods:Transfected and fluorescently tagged HEK293 cells stably expressing either HPA-1a or HPA-1b of αIIbβ3 were generated. The cyan (CFP) and yellow fluorescent protein (YFP) were cloned to the C-termini of the β3 and αIIb subunits prior to cell transfection. To explore conformational changes in the cytoplasmic tails and the activation of integrin, dynamic measurements were performed by fluorescence resonance energy transfer (FRET) under static and dynamic conditions (shear rates of 100 to 1600 s−1) using an established flow model. Results:Functional integrity of both integrin variants and correct membrane insertion were examined by flow cytometry and documented intact activation of αIIbβ3 in the transfected cells upon phorbol 12-myristate 13-acetate-induced (PMA)-induced stimulation of protein kinase C and specific binding of alexa647 fibrinogen (Fg) to αIIbβ3 upon inside-out activation. In the presence of abciximab, binding of alexa647 Fg to αIIbβ3 was completely blocked in both isoforms (PMA, mean: 119 units vs. abciximab 10 units). Upon cell adhesion under static condition and subsequent outside-in signaling, the HPA-1b isoform displayed a quantitatively different activation pattern than HPA-1a, as detected by FRET analyses. Thus, FRET signals, defined by the ratio of acceptor to donor fluoresecence intensity, revealed a faster and more distinct decrease in HPA-b (67+5) than in HPA-1a (75+6) (HPA-1b vs. HPA-1a, p=0.0053). This finding corresponds to are more pronounced spatial separation of the cytoplasmic tails in the HPA-1b variant of αIIbβ3. By contrast, stimulation with PMA (1 μM) caused an opposite effect in HPA-1a transfectants, as compared to HPA-1b (p<0.001), indicative of a distinct property upon inside-out activation. Upon interaction of αIIbβ3 with immobilized fibrinogen to induce outside-in signaling, HPA-1b exhibited an increased activation of the phosphotyrosine motif at residue Y418 (pY418) of the αIIbβ3-associated Src kinase, as compared with HPA-1a (p<0.05). No such difference was observed in Src phosphorylation upon stimulation with PMA (inside-out signaling). These findings suggest that the HPA-1 polymorphism of αIIbβ3 can modulate indeed outside-in signaling upon interaction of the transfectants with immobilized fibrinogen. When αIIbβ3-transfected HEK293 cells adherent onto immobilized fibrinogen were exposed to increasing arterial shear rates (800 to 1600 s−1), FRET analyses and digital imaging confirmed a more pronounced spatial separation of the cytoplasmic tails (αIIb-CFP; β3-YFP) in HPA-1b than in HPA-1a cells (p=0.0029). Likewise, the rate of residual adherent cells was significantly higher with HPA-1b than HPA-1a cell clones (p<0.0001). Interestingly, only arterial (> 800 s−1) but not venous shear rates increased the observed conformational changes in adherent HPA-1b cells. Conclusions:Our findings suggest that the prothrombotic phenotype of the HPA-1b variant is caused by increased outside-in signaling. The observed quantitative differences between both HPA-1 isoforms of αIIbβ3 are related to distinct conformational changes in their C-terminal cytoplasmic tails. These findings are in agreement with the contention that the HPA-1 polymorphism of αIIbβ3 can have a major impact on platelet adhesion, aggregation and thrombus formation under pathological conditions resulting from abnormally high shear stress. Disclosures:No relevant conflicts of interest to declare.

Increased Cardiac Troponin-T in Patients without Myocardial Infarction

There have been recently reports on elevated levels of cardiac troponins in patients without acute myocardial infarction (AMI). The purpose of the study was to analyze final diagnoses in patients with elevated cardiac troponin-T levels without clinical manifestations and characteristic ECG changes in AMI. Subjects and materials. The study included 72 patients (48 males and 24 females whose age ranged from 54 to 87 years (mean 69.8±11.2 years)). The criterion for inclusion was increased cardiac troponin-T; the primary criteria for exclusion were AMI-specific anginal pains and characteristic ECG changes (ST-segment elevation, abnormal Q waves). The definitive diagnosis of AMI was established only in 29 (40.3%) patients; the remaining 43 patients were diagnosed as having the following diseases: sepsis (n=21), cancer (n=10), diabetic nephropathy with chronic renal failure (n=6), cerebral infarction (n=4), and B12-deficiency anemia (n=2). In deceased patients, the level of troponin-T was higher than that in those who was discharged from hospital irrespective of the underlying disease. Results. There was a direct correlation between the level of cardiac troponin-T and the SAPS II index that reflects the general condition of a patient (r=0.44; p=0.0001) and an inverse correlation between the former and the left ventricular ejection fraction (r=-0.45; p=0.003). Conclusion. Thus, despite its cardiac specificity and its detection in the blood of critically ill patients without other manifestations of AMI, cardiac troponin-T is not a specific symptom of AMI, but suggests the severity of the disease, possibly, with the involvement of the myocardium in the pathological process. Key words: cardiac troponins, myocardial infarction, multiple organ dysfunction, systemic inflammatory reaction.

Transient global amnesia as a manifestation of acute myocardial infarction: A case of missed sudden cardiac death?

Acute myocardial infarction may lead to several clinical manifestations and many times this diagnosis is missed. Transient global amnesia (TGA) is a well-defined clinical syndrome of unknown etiology. Several mechanisms have been proposed but only trigger events have been clearly associated with the attack. We describe a case of acute myocardial infarction manifestated by TGA.

Epidemiology, Clinical Features, and Prognosis of Acute Myocardial Infarction in the Elderly

The incidence and prevalence of acute myocardial infarction (MI) increase progressively with age. In the United States, over 60% of acute MIs occur in patients 65 years of age or older, and approximately one third occur in persons over age 75. In addition, mortality rates following acute MI increase exponentially with age, such that approximately 60% of all MI deaths in the United States occur in the 6% of the population 75 years of age or older. The clinical features of acute MI vary by age. In particular, very elderly patients are less likely than younger patients to report chest pain. Conversely, confusion or altered mental status may be the presenting manifestation of acute MI in up to 20% of patients over 85 years of age. Older patients are also more likely to have "silent" or unrecognized MIs, as well as MIs without ST-segment elevation, compared with younger patients. Elderly patients with acute MI are more likely than younger patients to experience heart failure, atrial fibrillation, cardiac rupture, and shock, all of which are associated with increased mortality. Other factors contributing to the poor prognosis following acute MI in elderly individuals include a marked decline in cardiovascular reserve in the elderly, increased prevalence of comorbid conditions, underutilization of evidence-based therapies, and increased risk of iatrogenic complications.

Acute Myocardial Infarction in Young Japanese Adults Clinical Manifestations and In-Hospital Outcome

The prevalence and clinical manifestations of acute myocardial infarction (AMI) in young patients in Japan have not been fully investigated. In the present study, 1651 AMI patients were enrolled in the AMI-Kyoto Multi-Center Risk Study between January 2000 and June 2004. Of these, the clinical background, risk factors, angiographic findings, acute results of primary percutaneous coronary intervention (PCI) and in-hospital outcomes for 27 young patients <40 (young group), and 338 non-young patients 60<or=, <70 years old (non-young group) were retrospectively compared. The young AMI patients were all male. Current smoking, hypercholesterolemia and family history were the most common risk factors in young patients, while hypertension and diabetes mellitus were more prevalent in non-young patients. Young patients had a higher prevalence of single-vessel disease and a lesser incidence of left circumflex coronary artery as a culprit lesion. The young group had high acquisition rates of Thrombolysis In Myocardial Infarction 3 flow just after primary PCI (95.8%) and no in-hospital deaths, which was not significantly different from the non-young group. These results suggest that young AMI patients have different clinical characteristics from those in non-young AMI patients, and acute results of primary PCI and in-hospital prognosis in young AMI patients are comparable to those in non-young AMI patients in Japan.

Clinical Manifestation of Acute Myocardial Infarction in the Elderly

A retrospective study were performed in patients with acute myocardial infarction (AMI) that hospitalized in ICCU Cipto Mangunkusumo hospital, Jakarta during the period of January 1994 until Decmber 1999. There were 513 patients hospitalized with MCI, 227 patients (44.2%) were classified as elderly, and 35.2% of them were female. Most of the elderly AMI patients reported typical chest pain just like their younger counterparts. Elderly AMI patients tend to come later to the hospital, and more Q-wave myocardial infarction were identified compared to non- Q-wave myocardial infarction. Risk factors of diabetes mellitus and hypertension were more common among the elderly. The prevalence of atrial fibrillation and the mortality rate were higher among elderly AMI patients. (Med J Indones 2003; 12: 229-35)

Clinical manifestations of acute myocardial infarction in older patients.

Coronary artery disease is the major cause of morbidity and mortality in the elderly in the United States. In this age group, the clinical presentation of coronary heart disease can be quite atypical. In general, the incidence of typical precordial chest pressure/pain denoting myocardial ischemia is less common, whereas dyspnea as an anginal-equivalent symptom is frequent. The diagnosis of ischemic cardiac pain is frequently confused by the many comorbid conditions present in the elderly. Even when classic ischemic precordial discomfort is present, it tends to be less severe and less well defined. The elderly appear to have reduced pain perception; as a result, silent myocardial ischemia is more common and carries a somewhat worse prognosis in the elderly than in younger age groups. Similarly, the presenting symptoms of acute myocardial infarction in the elderly can be nonspecific. The classic crushing substernal chest pain decreases with age, whereas the symptom of dyspnea gradually increases. Neurologic symptoms, confusional states, weakness, and worsening heart failure are common clinical presentations of an acute infarction in elderly patients. Silent (unrecognized) myocardial infarctions are common in the elderly and carry serious prognostic implications.

Electrocardiographic diagnosis of acute myocardial infarction: Current concepts for the clinician

Background Over the past 2 decades, the 12-lead electrocardiogram has attained special significance for the diagnosis and triage of patients with chest pain because timely detection of myocardial injury and a rapid assessment of myocardium at risk proved pivotal to implementing effective reperfusion therapies during acute myocardial infarction. However, this wealth of information could still be underutilized by clinicians who may restrict their diagnostic quest in patients with chest pain to the more classic electrocardiographic signs. Methods The medical literature on electrocardiographic manifestations of acute myocardial infarction was extensively reviewed. Results The widespread utilization of both coronary angiography and methods to determine myocardial function and metabolism in patients with acute myocardial infarction over the last 10 years has provided the means for rigorous comparisons with electrocardiographic information. We summarize these electrocardiographic signs and patterns in terms of their relevance to the clinician to help reduce the incidence of “nondiagnostic electrocardiograms” and improve timely decision-making. Conclusions The electrocardiogram continues to be an invaluable tool in the initial evaluation of patients with chest pain. The plethora of data currently available on electrocardiographic changes correlating with myocardial injury allows clinicians to make faster and better decisions than ever before. (Am Heart J 2001;141:507-17.)