Medical History Of Myocardial Infarction Research Articles

Contemporary algorithms for diagnosing obstructive coronary artery disease in real clinical practice

Background. Despite the high evidence level of the currently existing international recommendations on stable coronary heart disease (CHD) and chronic coronary syndrome, their implementation in domestic clinical practice is insufficient.The aim of the work. To analyze the choice of diagnostic tactics (non-invasive and invasive) in patients with suspected obstructive coronary heart disease in real clinical practice.Methods. The study included outpatients with suspected obstructive CHD, in whom the pre-test probability (PTP) of obstructive CHD was determined; if PTP = 5–15 %, clinical probability was assessed based on CHD risk factors. Based on the results of coronary angiography, the following groups were identified: group I – obstructive lesion of the coronary arteries (≥ 70 %) (n = 50); group II – non-obstructive lesion of the coronary arteries (< 70 %) (n = 32); group III – intact coronary arteries (n = 40). Results. According to the results of coronary angiography, the frequency of detection of obstructive lesion of the coronary arteries was 42 % (in patients without past medical history of myocardial infarction – 31 %). Before performing coronary angiography, non-invasive tests were performed in 2.5 % of cases. Pain in the chest was represented by typical angina in 74 % of patients, with no difference in frequency in all groups. PTP values were statistically significantly higher in the group with obstructive CHD (median – 32 %), however, in the other two groups, PTP values corresponded to a high risk of obstructive CHD (median – 27 % and 21 %, respectively). PTP was an independent predictor for obstructive CHD and subsequent myocardial revascularization.Conclusion. In the cohort of outpatients with suspected coronary heart disease we examined during invasive coronary angiography, the frequency of obstructive lesion of the coronary arteries remains low. Non-invasive tests were performed in isolated cases, while PTP was an independent predictor for obstructive CHD and subsequent myocardial revascularization. To increase the frequency of detection of obstructive coronary heart disease, we should adhere to the diagnostic algorithms of the European Society of Cardiology and make wider use of non-invasive imaging tests.

Preparation of patients with type 2 diabetes mellitus for elective percutaneous coronary intervention

Aim. To assess the quality of preparation of patients with type 2 diabetes mellitus for elective percutaneous coronary intervention, which is aimed to achieving the target values of the modifiable cardiovascular risk factors.Materials and Methods. We retrospectively analysed 100 electronic medical records of patients with type 2 diabetes mellitus who were admitted for elective percutaneous coronary intervention at Research Institute for Complex Issues of Cardiovascular Diseases from 2021 to 2022. We analysed clinicopathological data, the data from clinical laboratory tests, and pharmacological anamnesis.Results. The average age was 65.19 ± 8.69 years, and the proportion of women was 59%. Smoking history and obesity were reported in 22% and 55% of patients, respectively, with average body mass index of 30.38 [27.66; 34.87] kg/m2. All patients suffered from arterial hypertension, 55% had past medical history of myocardial infarction, and 15% had atrial fibrillation. The duration of type 2 diabetes mellitus was 10 [3; 12] years. Target blood pressure at the admission was achieved in 40% patients. Average total cholesterol and blood glucose were 4.15 [3.50; 5.10] mmol/L and 7.85 [6.15; 11.00] mmol/L, respectively. Beta blockers, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, and statics were received by 90%, 89%, and 97% of patients. Maximum statin dose was registered in 27% patients, combined therapy (statin + ezetimibe) was documented in 4% patients. 14% of patients did not take hypoglycemic drugs. Oral hypoglycemic agents were received in 65% (in most cases biguanides and sulphonylureas, in 7% patients they were combined with insulin). Sodium-dependent glucose cotransporter (SGLT2) inhibitors have been taken by 19% of patients.Conclusion. Patients with type 2 diabetes mellitus recommended for elective percutaneous coronary intervention typically suffer from arterial hypertension and frequently had increased body mass index, total cholesterol, and blood glucose. The prevalence of using antihypertensive drugs, oral hypoglycemic agents, and lipid-lowering drugs should be increased.

Circulating Endothelial Cells are Associated with Thromboembolic Events in Patients with Antiphospholipid Antibodies.

Endothelial damage has been described in antiphospholipid antibody (aPL)-positive patients. However, it is uncertain whether circulating endothelial cells (CECs)-which are released when endothelial injury occurs-can be a marker of patients at high risk for thrombosis. Ninety-seven patients with aPL and/or systemic lupus erythematosus (SLE) were included. CECs were determined by an automated CellSearch system. We also assayed plasma levels of tissue factor-bearing extracellular vesicles (TF+/EVs) and soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) as markers of endothelial dysfunction/damage. Patients' mean age was 46.1 ± 13.9 years, 77 were women. Thirty-seven had SLE and 75 patients were suffering from antiphospholipid syndrome. Thirty-seven percent of patients presented a medical history of arterial thrombosis and 46% a history of venous thromboembolism (VTE). Thirteen patients had increased levels of CECs (>20/mL), with a mean CEC level of 48.3 ± 21.3 per mL. In univariate analysis, patients with obesity or medical history of myocardial infarction (MI), VTE, or nephropathy had a significant increased CEC level. In multivariate analysis, obesity (odds ratio [OR] = 6.07, 95% confidence interval [CI]: 1.42-25.94), VTE (OR = 7.59 [95% CI: 1.38-41.66]), and MI (OR = 5.5 [95% CI: 1.1-26.6)] were independently and significantly associated with elevated CECs. We also identified significant correlations between CECs and other markers of endothelial dysfunction: sTREM-1 and TF+/EVs. This study demonstrated that endothelial injury assessed by the levels of CECs was associated with thromboembolic events in patients with aPL and/or autoimmune diseases.

Myocardial Infarction Is Associated With Increased Stroke Severity, In-Hospital Mortality, and Complications: Insights From China Stroke Center Alliance Registries.

BackgroundPrior studies have shown an increased risk of ischemic stroke (IS) after myocardial infarction (MI); however, there are limited studies concerning the characteristics, in‐hospital mortality, and complications of patients with IS with a medical history of MI. We hypothesized that patients with IS with a medical history of MI may experience more severe strokes and have a higher risk of in‐hospital mortality and complications than patients with IS without a medical history of MI.Methods and ResultsConsecutive in‐hospital data were extracted from the China Stroke Center Alliance database from August 2015 to July 2019. Patient characteristics, hospital tests, in‐hospital mortality, and complications were analyzed and compared in patients with IS with or without a history of MI. Of 893 429 patients with IS, we identified 81 646 (9.1%) patients with a history of MI (MI group). Compared with patients with IS without MI, MI group patients were older, had a lower prevalence of current smoking, had a higher prevalence of a relative medical history, and took more medications before admission. Compared with the group with IS without MI, the MI group had a higher National Institute of Health Stroke Scale score after onset (4.0 versus 3.0; Hodges‐Lehmann estimator, 22.5) and a higher proportion of severe strokes (National Institute of Health Stroke Scale score ≥15) (7.1% versus 4.4%; absolute standardized difference=11.6%). In the fully adjusted models, the risk of in‐hospital mortality was higher in the MI group (odds ratio [OR], 1.74; 95% CI, 1.57–1.92; P<0.0001). MI group patients also had a higher risk of complications, including urinary tract infection (OR, 1.28; 95% CI, 1.2–1.36; P<0.0001), gastrointestinal bleeding (OR, 1.29; 95% CI, 1.19–1.39; P<0.0001), pneumonia (OR, 1.24; 95% CI, 1.21–1.28; P<0.0001), depression (OR, 1.33; 95% CI, 1.24–1.42; P<0.0001), seizure (OR, 1.35; 95% CI, 1.22–1.49; P<0.0001), atrial fibrillation (OR, 1.78; 95% CI, 1.71–1.86; P<0.0001), and cardiac or respiratory arrest (OR, 1.98; 95% CI, 1.78–2.2; P<0.0001).ConclusionsPatients with IS with a medical history of MI have an increased risk of severe stroke, in‐hospital mortality, and complications. Studies exploring the underlying mechanisms are needed to improve and tailor stroke treatment strategies.

Idiopathic systemic capillary leak syndrome (Clarkson’s disease) presenting with recurrent hypovolemic shock

A 49-year old male with a past medical history of myocardial infarction and compartment syndromes requiring fasciotomies presented on five occasions with hypovolemic shock. We describe his admissions and presumptive diagnoses which required large volumes of intravenous fluids, admission to intensive care for vasopressors and renal replacement therapy. The presentations were always precipitated by a prodrome of fatigue and pre-syncopal episodes. On his last admission, a diagnosis of Idiopathic systemic capillary leak syndrome (ISCLS), also known as Clarkson’s Disease, was reached. He is currently receiving high dose intravenous immunoglobulins on a monthly basis.

MASKED SEPSIS DUE TO ACUTE CHOLECYSTITIS IN A PATIENT WITH CARDIOPULMONARY DISEASE LEADING TO SEPTIC SHOCK: A CASE REPORT

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Sepsis is a primary cause of death in nearly 23.5% of chronic heart failure patients. The relationship between acute cholecystitis and cardiovascular disease is vague but there have been few studies suggesting cholecystocardiac link. Here we describe a similar case that presented as pulmonary edema and myocardial ischemia. CASE PRESENTATION: 81-year-old male with past medical history of myocardial infarction, chronic obstructive pulmonary disease, hypothyroidism, hypertension, hyperlipidemia presented to the emergency department with worsening exertional dyspnea for the past 3 days. On physical examination he was afebrile, tachycardic, hypoxic requiring 4L oxygen. Chest auscultation revealed bibasilar rales. Electrocardiogram showed ST segment depression in lateral leads and troponins were elevated at 1.56. Labs showed mild leukocytosis, BNP 1658, Creatinine 1.8 and normal hepatic panel. Chest X-Ray suggested pulmonary edema for which he was diuresed. He was started on heparin drip. Echocardiogram showed reduced ejection fraction of 40%. Cardiac catheterization showed multivessel disease and moderate pulmonary hypertension. Coronary artery bypass surgery was recommended. Next day he developed mild periumbilical pain, which later moved to his right upper quadrant. CT abdomen showed cholelithiasis with pericholecystic inflammation. Cholescintigraphy confirmed acute cholecystitis. Patient started becoming more dyspneic and pulmonary edema worsened. He became hypotensive and febrile. Sepsis bundle was initiated including blood cultures, broad spectrum antibiotics and intravenous fluids. Patient was intubated and transferred to critical care unit. He required multiple pressors. Continuous hemodialysis was started for metabolic acidosis. Blood cultures revealed gram negative bacteremia. Unfortunately, the patient could not be saved. DISCUSSION: Gallbladder edema may be a response to the ischemia caused by cardiac instability. The exact mechanism linking acute cholecystitis to extracholecystic diseases is unknown, but it is likely due to an increase in portal venous pressure along with a decrease in plasma oncotic pressure. Chronic cardiopulmonary diseases and aging can cause immune-senescence that may increase the risk of sepsis which sometimes does not meet SIRS criteria. These patients, especially when on betablockers, cannot meet increased metabolic demands. Irritation and spasticity of the gallbladder can create reflex stimuli through the autonomic pathways, which leads to temporary alteration in coronary blood flow. CONCLUSIONS: Acute cholecystitis may coexist with or be misdiagnosed as a cardiovascular disorder. Looking for signs of end organ dysfunction or subtle vital sign irregularities may help identify older patients who are on their way to decompensation and allow us to intervene earlier with appropriate investigations and treatment which may lead to the prevention of fatal events. Reference #1: Ozeki M, Takeda Y, Morita H, et al. Acute cholecystitis mimicking or accompanying cardiovascular disease among Japanese patients hospitalized in a Cardiology Department. BMC Res Notes. 2015;8:805. Published 2015 Dec 19. doi:10.1186/s13104-015-1790-8 Reference #2: Walker AMN, Drozd M, Hall M, et al. Prevalence and Predictors of Sepsis Death in Patients With Chronic Heart Failure and Reduced Left Ventricular Ejection Fraction. J Am Heart Assoc. 2018;7(20):e009684. doi:10.1161/JAHA.118.009684 Reference #3: Meelu OA, Baber U, Theodoropoulos K, Mennuni MG, Kini AS, Sharma SK. Acute cholecystitis and myocardial infarction: a case study with coronary involvement. Clin Case Rep. 2016;4(8):793-796. Published 2016 Jul 13. doi:10.1002/ccr3.621 DISCLOSURES: No relevant relationships by Aditya Bansal, source=Web Response No relevant relationships by Hina Farrukh, source=Web Response No relevant relationships by sreeja sompalli, source=Web Response

Imaging of Clinically Unrecognized Myocardial Fibrosis in Patients With Suspected Coronary Artery Disease

BackgroundStress cardiac magnetic resonance (CMR) provides accurate assessment of both myocardial infarction (MI) and ischemia. ObjectivesThis study aimed to evaluate the incremental prognostic value of unrecognized myocardial infarction (UMI), detected during assessment of coronary artery disease (CAD) by stress CMR, beyond cardiac function and ischemia. MethodsIn the multicenter SPINS (Stress CMR Perfusion Imaging in the United States) study, 2,349 consecutive patients (63 ± 11 years of age, 53% were male) with suspected CAD were assessed by stress CMR and followed over a median of 5.4 years. UMI was defined as the presence of late gadolinium enhancement consistent with MI in the absence of medical history of MI. This study investigated the association of UMI with all-cause mortality and nonfatal MI (death and/or MI), and major adverse cardiac events (MACE). ResultsUMI was detected in 347 patients (14.8%) and clinically recognized myocardial infarction (RMI) in 358 patients (15.2%). Compared with patients with RMI, patients with UMI had a similar burden of cardiovascular risk factors, but significantly lower left ventricular ejection fraction (p < 0.001) and lower rates of guideline-directed medical therapies, including aspirin (p < 0.001), statin (p < 0.001), and beta-blockers (p = 0.002). During follow-up, 328 deaths and/or MIs and 528 MACE occurred. In univariate analysis, UMI and RMI were strongly associated with death and/or MI (UMI: hazard ratio [HR]: 2.15; 95% confidence interval [CI]: 1.63 to 2.83; p < 0.001; RMI: HR: 2.45; 95% CI: 1.89 to 3.18) and MACE. Compared with patients with RMI, patients with UMI presented an increased risk for heart failure hospitalization (UMI vs. RMI: HR: 2.60; 95% CI: 1.48 to 4.58; p < 0.001). In a multivariate model including ischemia and left ventricular ejection fraction, UMI and RMI maintained robust prognostic association with death and/or MI (UMI: HR: 1.82; 95% CI: 1.37 to 2.42; p < 0.001; RMI: HR: 1.54; 95% CI: 1.14 to 2.09) and MACE. ConclusionsIn a multicenter cohort of patients with suspected CAD, presence of UMI or RMI portended an equally significant risk for death and/or MI, independently of the presence of ischemia. Compared with RMI patients, those with UMI were less likely to receive guideline-directed medical therapies and presented an increased risk for heart failure hospitalization that warrants further study. (Stress CMR Perfusion Imaging in the United States [SPINS]; NCT03192891)

Urinary orosomucoid: a new marker of cardiovascular risk in psoriatic patients?

PurposePsoriasis is one of the most common lifelong lasting dermatologic diseases. According to the latest studies, psoriatic patients have a higher risk of developing cardiovascular diseases. Psoriasis is considered as a systemic inflammatory disease. Several oxidative stress markers have been shown to be elevated in psoriasis. However, a panel of biomarkers has not been used yet. This study was aimed at exploring the connection between a panel of biomarkers (C-reactive protein, asymmetric dimethylarginine, uric acid, total antioxidant capacity, malondialdehyde, and orosomucoid [ORM]) and cardiovascular risk in psoriatic patients.Patients and methodsThe inclusion criterion was the onset of psoriasis with skin lesions. Exclusion criteria were impaired renal function (eGFR<60 mL/min/1.73 m2), acute inflammations (urinary, respiratory, skin inflammation, etc), autoimmune disorders (rheumatoid arthritis, systemic lupus erythematosus, or inflammatory bowel disease), and any kind of biological antipsoriatic treatment. Patients with a medical history of myocardial infarction, coronary heart disease, stroke, transient ischemic attack, and carotid artery stenosis were also excluded. Biomarkers were measured by routine procedures, ELISA and HPLC. QRISK®2-2017 was used to assess 10-year risk of cardiovascular disease development. Psoriasis severity was measured by the Psoriasis Area and Severity Index.ResultsOne hundred and fourteen psoriatic patients were enrolled. Only urinary orosomucoid and urinary orosomucoid/urinary creatinine (u-ORM/u-CREAT) ratio showed significant correlation with QRISK score (u-ORM, r=0.245; u-ORM/u-CREAT, r=0.309). When comparing mild psoriatic patients to moderate psoriatic patients, significant differences could only be found in u-ORM and u-ORM/u-CREAT ratio.ConclusionThere seems to be a connection between urinary ORM and cardiovascular risk. U-ORM and u-ORM/u-CREAT ratio could be used as an indicator of low-grade inflammation in mild and moderate psoriasis. However, it is the 10-year follow-up of cardiovascular events that will determine the usefulness of this biomarker panel.

Analysis of risk factors and clinical features in elderly patients with nonalcoholic fatty liver disease combined with mild cognitive impairment

Objective To investigate the risk factors for NAFLD patients with mild cognitive impairment (MCI) in elderly through comparing the clinical features among elderly NAFLD patients with MCI. Methods A total of one hundred and sixteen elderly patients with NAFLD were enrolled in this study and were divided into MCI group (37 cases) and non-MCI group (79 cases). The clinical data including medical history of myocardial infarction, diabetes mellitus, hypertension, medications, blood pressure, BMI, liver function, kidney parameters, glucose metabolism, serum lipid profile, vitamin D, NAFLD fibrosis score, HOMA-IR and carotid plaques were analyzed and compared. Results Compared with non-MCI group, the age, AST/ALT ratio, serum creatinine, NAFLD fibrosis score, serum uric acid of MCI group were significantly higher ((80.5±7.4)years vs.(72.5±8.0)years, t=5.87, P<0.001; (1.33±0.51) vs.(1.09±0.30), t=2.599, P=0.012; (100.86±78.02) μmol/L vs.(78.12±22.12) μmol/L, t=2.402, P=0.018; (0.73±1.01) vs.(0.03±1.17), t=3.132, P=0.002; (382.95±79.61) μmol/L vs (349.99±79.18) μmol/L, t=2.086, P=0.039), while serum γ-glutamyl transpeptidase (γ-GT), diastolic blood pressure (DBP), estimated glomerular filtration rate (eGFR) of MCI group were significantly lower than those in the non-MCI group (22.00(17.00, 26.00) U/L vs.28.00(19.00, 39.50) U/L, Z=-3.038, P=0.002; (69.30±6.78) mmHg vs.(74.30±9.45)mmHg, t=-3.252, P=0.002; (62.60±17.78)(ml/min×1.73 m2) vs.(79.41±16.95)(ml/min×1.73 m2 ), t=-4.900, P<0.001). Detection rates of carotid unstable plaques and high BMI in MCI group were higher than those in the non-MCI group (83.78%(31/37) vs.64.56%(51/79), χ2=4.496, P=0.034)(83.78%(31/37) vs.60.76%(48/79), χ2=6.149, P=0.013). There were no significantly differences between the two groups in history of myocardial infarction, diabetes mellitus, hypertension, usage rates of antiplatelet drugs and statins.Logistic regression showed that age (regression coefficient=0.166, OR=1.181, 95%CI 1.078-1.293, P<0.001), high BMI (regression coefficient=1.942, OR=6.974, 95%CI 1.466-33.176, P=0.015), diastolic blood pressure (regression coefficient=-0.099, OR=0.905, 95%CI 0.828-0.990, P=0.029), γ-GT (regression coefficient=-0.094, OR=0.910, 95%CI 0.852-0.972, P=0.005), serum uric acid (regression coefficient=-0.009, OR=1.009, 95%CI 1.000-1.017, P=0.039) and low density lipoprotein cholesterol(LDL-C) (regression coefficient=0.898, OR=2.454, 95%CI 1.029-5.854, P=0.043) were related to elderly NAFLD patients with MCI. Conclusion The high BMI, diastolic blood pressure, serum uric acid, low density lipoprotein are related to MCI in elderly patients with NAFLD.For elderly patients with NAFLD, these indicators may be used to assess the risk of MCI and to locate high-risk groups at an early stage. Key words: Nonalcoholic fatty liver disease; Mild cognitive impairment; Elderly

The Effect of Media Campaigns, Patient Characteristics, and Presenting Symptoms on Prehospital Delay in Myocardial Infarction Patients: A Prospective Cohort Study

Delays in reperfusion therapy for myocardial infarction (MI) are associated with increased mortality and morbidity, and most of this delay is due to delay in patients initiating contact with emergency services. This study assesses the impact of the Australian National Heart Foundation media campaign and identifies patient characteristics and presenting symptoms that may contribute to delay. This prospective cohort study identified patients with a diagnosis of MI admitted to a single tertiary metropolitan hospital in Perth, Western Australia from July 2013 to January 2014. Patients were interviewed and responses were categorised to determine their reasons for delaying treatment and the impact of mass media campaigns. Delay times were analysed using multivariable linear regression models for the Whole Cohort (all patients admitted to the tertiary hospital, including patients from rural and peripheral hospitals) and the Direct Admission Cohort (patients admitted directly to the tertiary hospital). Of 376 patients, 255 patients provided consent, and symptom onset-time was available for 175 patients. While almost two thirds of the cohort was aware of media campaigns, awareness was not associated with decreased prehospital delay. Median delay was 3.9hours for the Whole Cohort and 3.5hours for the Direct Admission Cohort. Delay was associated with being widowed, symptom onset on a weekday compared with weekend, past medical history of MI and coronary artery bypass graft, private compared with ambulance transport to hospital, and lack of symptoms of sweating and weakness. In addition, for the Direct Admission Cohort, age and income were also associated with delay. This study did not find an association between awareness of media campaigns and delay. This study identified important characteristics and presenting symptoms that are associated with delay, and possibly relevant to future media campaigns.

Abstract P305: Daily Walking Time and Pneumonia Mortality Among Elderly With/Without Medical History of Myocardial Infarction or Stroke

Several studies report that daily walking reduces the risk of pneumonia. However, the elderly often experience underlying chronic diseases such as myocardial infarction (MI) or stroke which also increase the risk of pneumonia; thus, the association of walking with pneumonia may merely be a result of confounding of the underlying conditions. Therefore, we explored the links between daily walking and pneumonia mortality stratified by the presence of medical histories in 22,280 Japanese elderly (9,067 men and 13,213 women) aged 65 to 79 years from 1988-1990. The Cox proportional hazards model was used to calculate hazard ratio (HR) and 95% confidence interval (CI) for pneumonia mortality (ICD10: J9-18, J69) adjusted for age, sex, and possible confounders. P for trend was calculated across the categories of walking time. After a median of 11.9 years’ follow-up, 1,203 participants died of pneumonia. In participants without a medical history of MI or stroke, the HR of pneumonia mortality in participants who had walked at baseline for ≥1 h/day was 0.73 (95% CI, 0.62-0.85; P for trend &lt;0.001), compared with those who had walked for 0.5 h/day. Participants with a medical history of MI who walked for ≥1 h/day also showed significantly decreased risk of pneumonia mortality (HR, 0.49; 95% CI, 0.27-0.92; P for trend = 0.01). No significant associations were found among participants with a medical history of stroke (HR, 0.82; 95% CI, 0.39-1.72), although P for trend was statistically significant (P for trend = 0.003). However, the HR of pneumonia mortality in participants who had walked at baseline for &lt;0.5 h/day was 1.46 (95% CI, 1.19-1.78) in participants without a medical history of MI or stroke, 1.06 (95% CI, 0.46-2.25) in participants with a medical history of MI, and 2.83 (95% CI, 1.35-5.95) in participants with a medical history of stroke. Our findings suggest that longer walking time may be beneficial in reducing the risk of pneumonia mortality in elderly populations.

Ankle brachial index most important to identify polyvascular disease in patients with non-ST elevation or ST-elevation myocardial infarction

BackgroundAtherosclerosis is a systemic disease. In patients with acute myocardial infarction (MI) the extent of polyvascular disease (PvD) is largely unknown. In this study we investigate the prevalence and clinical characteristics predictive of PvD in patients with non-ST-elevation (NSTEMI) and ST-elevation (STEMI) MI. Method375 patients with acute MI included in the REBUS (Relevance of Biomarkers for Future Risk of Thromboembolic Events in Unselected Post-myocardial Infarction Patients) study were examined. Atherosclerotic changes were assessed in three arterial beds by coronary angiography, carotid ultrasound and ankle brachial index (ABI). Results compared findings of atherosclerosis in three arterial beds to fewer than 3 beds. PvD was defined as atherosclerosis in all three arterial beds. ResultsA medical history of MI, peripheral artery disease (PAD) or stroke was reported at admission in 17.9%, 2.1% and 3.7% of the patients, respectively. After evaluation, abnormal ABI was found in 20.3% and carotid artery atherosclerosis in 54.9% of the patients. In the total population, PvD was found in 13.8% of patients with no significant differences observed between NSTEMI and STEMI patients. Age (p<0.001), diabetes (p=0.039), previous PAD (p=0.009) and female gender (p=0.016) were associated with PvD. ABI was the most important predictor of PvD with a positive predictive value of 68.4% (95% CI 57.7–79.2%) and specificity of 92.4% (95% CI 89.5–95.4%). ConclusionsPvD is underdiagnosed in patients suffering from MI, both NSTEMI and STEMI. ABI is a useful and simple measurement that appears predictive of widespread atherosclerosis in these patients.

The association between phenomena on the Sun, geomagnetic activity, meteorological variables, and cardiovascular characteristic of patients with myocardial infarction

It has been found that solar and geomagnetic activity affects the cardiovascular system. Some evidence has been reported on the increase in the rate of myocardial infarction, stroke and myocardial infarction related deaths during geomagnetic storms. We investigated the association between cardiovascular characteristics of patients, admitted for myocardial infarction with ST elevation (STEMI), and geomagnetic activity (GMA), solar proton events (SPE), solar flares, and meteorological variables during admission. The data of 1,979 patients hospitalized at the Hospital of Lithuanian University of Health Sciences (Kaunas) were analyzed. We evaluated the association between environmental variables and patient's characteristics by multivariate logistic regression, controlling patient's gender and age. Two days after geomagnetic storms the risk of STEMI was over 1.5 times increased in patients who had a medical history of myocardial infarction, stable angina, renal or pulmonary diseases. The dose-response association between GMA level and STEMI risk for patients with renal diseases in history was observed. Two days after SPE the risk of STEMI in patients with stable angina in anamnesis was increased over 1.5 times, adjusting by GMA level. The SPE were associated with an increase of risk for patients with renal diseases in history. This study confirms the strongest effect of phenomena in the Sun in high risk patients.

Risk Factors for Death in Elderly Patients With Facial Fractures Secondary to Falls

Craniomaxillofacial trauma is associated with severe injuries and disability. There are no recent reports analyzing the demographics of facial trauma in elderly patients. Our objective was to review the demographics, outcomes, and risk factors associated with death in elderly patients with facial fractures in a single-institution level I trauma center. We performed a retrospective review of the University of Pittsburgh Medical Center Trauma Registry from January 1999 to December 2008 in an institutional review board-approved protocol. The search query included all types of craniofacial trauma using International Classification of Diseases, Ninth Revision coding. A χ test was used for analyzing categorical data. Continuous data were analyzed using unpaired t-test or analysis of variance. Logistic regressions were done to determine odds ratio (OR) for death. P = 0.05 was deemed significant. A total of 16,528 patients with facial trauma were identified. Of these, 4536 patients had falls. Among the falls, 1020 patients had facial fractures. Finally, 460 patients were younger than 65 years, and 560 were older than 65 years. The variable with the highest odds for mortality in patients with facial fractures was intensive care unit admission (OR, 13.1), followed by acute renal failure (OR, 10.3), medical history of myocardial infarction (OR, 5.1), coagulopathy (OR, 4.78), age older than 65 years (OR, 4.13), acute respiratory failure (OR, 3.55), Abbreviated Injury Scale score greater than 3 at the head (OR, 3.5), congestive heart failure (OR, 2.64), history of cardiac surgery (OR, 2.4), and vault skull fracture (OR, 2.35). Craniofacial trauma is a serious condition in the elderly. Associated injuries are demonstrated to have a deleterious effect on survival. Recognition of these risk factors is likely to promote the development of preventive measurements to decrease fatal outcomes.

Septicemia due to Capnocytophaga canimorsus following dog bite in an elderly male

A previously healthy, 67-year-old, man with past medical history of myocardial infarction and hypertension was rushed to the emergency room after sudden onset of fever, chills, severe rigors, hypotension, tachycardia and vomiting. The patient was diagnosed as being in septic shock, and investigations revealed intracellular gram-negative bacilli in polymorphonuclear leukocytes in the peripheral smear. A history of dog contact was elicited after this very unusual and rare finding. Cultures confirmed septicemia due to Capnocytophaga canimorsus, a normal oral and nasal flora inhabitant of cats and dogs that can cause severe and sometimes fatal septicemia in humans. We report this very interesting case because of the common prevalence of dog homeownership and the rarity of C. canimorsus inducing sepsis.

Bilateral facial pain from cardiac origin. A case report

A case of a 65-year-old female patient is reported. Her chief complaint was facial pain, so she sought care from her general dental practitioner for evaluation of a suspected temporomandibular disorder, after repeated visits to the emergency department due to excruciating facial pain associated with exertion. The dental examination revealed an edentulous upper and lower jaw. Radiographs of the facial bones revealed no abnormalities. Eventually, she was referred for cardiological evaluation, as her pain radiated to the chest and there was a medical history of myocardial infarction. Cardiac pain may radiate to the face and lead patients to seek dental care. In these settings, dentists may contribute to the diagnosis of ischemic heart disease and refer patients for cardiological evaluation.

Medical History of Circulatory Diseases and Colorectal Cancer Death in the JACC Study

BACKGROUND: Host factors expressed by individual past medical history of hypertension, stroke, and myocardial infarction may have a relationship with colorectal cancer.METHODS: As part of the Japan Collaborative Cohort Study (JACC Study) for the Evaluation of Cancer Risk sponsored by the Ministry of Education, Science, Sports and Culture of Japan (Monbusho), we conducted a follow-up study of 110,792 Japanese inhabitants aged 40-79 years to reveal the relationship of past medical history of hypertension, stroke, and myocardial infarction at the baseline in 1988-1990 with colorectal cancer death for about 10 years up to the end of 1999.RESULTS: Past medical history of hypertension associated with an increased risk of female rectal cancer when analyzing all cancer cases with adjustment for age, body mass index, and exercise (hazard ratio [HR] = 1.97, 95% confidence interval [CI]; 1.13-3.43). Past medical history of myocardial infarction was also an increased risk for female rectal cancer (HR = 3.05, 95% CI; 1.28-7.28). Females who had a medical history of stroke had increased risk of rectal cancer without statistical significance.CONCLUSION: There was a positive association of past medical history of hypertension and myocardial infarction and an increased risk of rectal cancer in women.

High dose alfentanil as sole anaesthetic induction agent for caesarean section in a patient with severe ischaemic heart disease

A 43-year-old woman presented at 34 weeks’ gestation with pre-eclampsia and intra-uterine growth restriction. She had a past medical history of myocardial infarction and had angina on moderate effort. She also had non-insulin dependent diabetes mellitus, chronic obstructive airways disease and hypercholesterolaemia. The onset of unstable angina, cardiac failure and a deteriorating fetal condition necessitated urgent delivery by caesarean section. General anaesthesia was chosen. High dose alfentanil was used as sole induction agent resulting in minimal haemodynamic change and a successful maternal and fetal outcome.

Cardiovascular disease in insulin dependent diabetes mellitus: similar rates but different risk factors in the US compared with Europe

Cardiovascular disease (CVD) in insulin dependent diabetes mellitus (IDDM) has been linked to renal disease. However, little is known concerning international variation in the correlations with hyperglycaemia and standard CVD risk factors. A cross-sectional comparison was made of prevalence rates and risk factor associations in two large studies of IDDM subjects: the Pittsburgh Epidemiology of Diabetes Complications Study (EDC) and the EURODIAB IDDM Complications Study from 31 centres in Europe. Subgroups of each were chosen to be comparable by age and duration of diabetes. The EDC population comprises 286 men (mean duration 20.1 years) and 281 women (mean duration 19.9 years); EURODIAB 608 men (mean duration 18.1 years) and 607 women (mean duration 18.9 years). The mean age of both populations was 28 years. Cardiovascular disease was defined by a past medical history of myocardial infarction, angina, and/or the Minnesota ECG codes (1.1-1.3, 4.1-4.3, 5.1-5.3, 7.1). Overall prevalence of CVD was similar in the two populations (i.e. men 8.6% versus 8.0%, women 7.4% versus 8.5%, EURODIAB versus EDC respectively), although EDC women had a higher prevalence of angina (3.9% versus 0.5%, P < 0.001). Multivariate modelling suggests that glycaemic control (HbA1c) is not related to CVD in men. Age and high density lipoprotein cholesterol predict CVD in EURODIAB, while triglycerides and hypertension predict CVD in EDC. For women in both populations, age and hypertension (or renal disease) are independent predictors. HbA1c is also an independent predictor-inversely in EURODIAB women (P < 0.008) and positively in EDC women (P = 0.03). Renal disease was more strongly linked to CVD in EDC than in EURODIAB. Despite a similar prevalence of CVD, risk factor associations appear to differ in the two study populations. Glycaemic control (HbA1c) does not show a consistent or strong relationship to CVD.