Form Of Myocardial Infarction Research Articles

From Atherosclerotic Plaque to Myocardial Infarction-The Leading Cause of Coronary Artery Occlusion.

Cardiovascular disease (CVD) constitutes the most common cause of death worldwide. In Europe alone, approximately 4 million people die annually due to CVD. The leading component of CVD leading to mortality is myocardial infarction (MI). MI is classified into several types. Type 1 is associated with atherosclerosis, type 2 results from inadequate oxygen supply to cardiomyocytes, type 3 is defined as sudden cardiac death, while types 4 and 5 are associated with procedures such as percutaneous coronary intervention and coronary artery bypass grafting, respectively. Of particular note is type 1, which is also the most frequently occurring form of MI. Factors predisposing to its occurrence include, among others, high levels of low-density lipoprotein cholesterol (LDL-C) in the blood, cigarette smoking, chronic kidney disease (CKD), diabetes mellitus (DM), hypertension, and familial hypercholesterolaemia (FH). The primary objective of this review is to elucidate the issues with regard to type 1 MI. Our paper delves into, amidst other aspects, its pathogenesis, risk assessment, diagnosis, pharmacotherapy, and interventional treatment options in both acute and long-term conditions.

COVID-19-induced Neonatal Acute Aortic Thrombosis

Abstract Venous thromboembolism is a well-recognized, common complication of a severe COVID-19 disease. Arterial thrombosis is a less known complication, now being reported increasingly, mostly in the form of myocardial infarction and stroke, but acute aortic occlusion is infrequent. Neonatal acute aortic thrombosis as a sequelae of COVID-19 disease has far uncommon incidence with no literature-based evidence till date. A 10-day-old male child presented to the emergency department with informant being his mother with complaints of black discoloration of his right foot for 4 days noticed first on his toes. No history of trauma, no history of fever, and no history of umbilical artery catheterization at birth was noted. Birth history-full term normal vaginal delivery, small for gestational age baby, cried immediately after birth, birth weight – 2.45 kg with no additional birth events. No history of neonatal intensive care unit stay, immunized at birth. Baby was 3rd by order of birth with no congenital anomalies noted in previous siblings. On examination, the baby was alert, afebrile, heart rate – 138/min, blood pressure – 90/60 mmHg, and SpO2 98% on room air. Local examination of the right lower limb revealed black discoloration of the right lower limb from toes up to mid-calf, CRT-delayed in the right thigh (7 s), right femoral pulsations absent, left lower limb – pink, warm, CRT – 6 s, feeble pulsations of left femoral artery and popliteal artery, absent pulsations of left anterior tibial artery, and posterior tibial artery. A Doppler study revealed the presence of partial lumen occluding thrombus (hyperechoic) in abdominal aorta below the level of renal arteries, absent flow in right lower limb, and monophasic flow in left femoral artery. A prothtrombotic screen was performed and COVID-19 antibody test was found to be positive. A systemic thrombolysis with injection reteplase was performed which showed mild improvement in circulation with propagation of clot up to origin of superior mesentric artery on a Doppler scan. An abdominal aortic embolectomy was performed, with retrieval of a long segment thrombus from distal abdominal aorta and bilateral femoral arteries following good proximal inflow and good distal backflow. Bilateral limb perfusion improved postoperatively though the gangrenous right lower limb could not be saved and a right below knee amputation was performed for the same. This case adds to the growing list of potential sites and consequences of thrombosis in COVID-19 infection. We speculate that this case of aortic thrombosis was a result of direct COVID-19-induced vascular damage in the context of a hypercoagulable state with a possibility of vertical transmission of the disease.

Effect Of Emotional Freedom Technique On Pre Percutaneous Coronary Intervention Patients' Anxiety In Hospital

Coronary heart disease is a degenerative disease. One of the techniques that can open blood vessels and return blood through the coronary arteries is Percutaneous Coronary Intervention (PCI). Hemodynamic conditions are one of the patient's preparations for PCI, but anxiety can respond to the cardiovascular system, one of which is a disturbance in a person's hemodynamics. Problems that often arise in pre PCI patients are anxiety.Percutaneous Coronary Intervention is one of the techniques that have been invented to open the blood vessels and return blood through the coronary arteries (PCI). PCI, also known as cardiac catheterization, is a procedure that involves inserting one or more catheters into the heart and blood arteries. The catheter is inserted through a peripheral vessel, usually femoral, then non-operatively invasive so that complications can be kept as low as possible. Percutaneous Coronary Intervention (PCI) can cause complications in the form of myocardial infarction, stroke, arrhythmia and death. This causes a person to feel himself threatened, someone feels himself threatened can cause the effect of Anxiety (anxiety). The problem that often arises in pre PCI patients is anxiety. One of the efforts to overcome anxiety is the Emotional Freedom Technique (EFT). This type of research is a quantitative study using a quasi-experimental design with a pretest-posttest with a control group, namely by conducting a pretest in both groups and followed by an intervention in the experimental group and then conducting a posttest in both groups, with a sample of 34 respondents. The results showed that the effect of EFT on the anxiety of pre PCI patients in the intervention group with p-value = 0.000, while in the control group with p-value = 0.650. Furthermore, it is hoped that clients who will undergo PCI will not be hindered from doing PCI because the client has been given Emotional Freedom Technique (EFT) therapy.

CLINICAL AND MORPHOLOGICAL CHARACTERISTICS OF COVID-19 ASSOCIATED MYOCARDITIS

The article is devoted to the actual problem in the case of ongoing COVID-19 pandemic – the clinical and morphological characteristics of СOVID-19 associated myocarditis in conditions of non-widespread of this topic. The aim of the study is to study the clinical and morphological features of COVID-19 associated heart damage in deceased patients. The study included data from medical cards of inpatients of Almaty City cardiological center, as well as postmortem data of 12 patients (9 men and 3 women, average of age 65,6±13,8, 51–80 years), dead patients with a diagnosis of atherosclerosis-associated diseases. Pathological anatomical autopsy was performed at the Central Pathological Anatomical Department of Federal Health Institution “Central Medical and Sanitary Unit No. 1 of the Federal Medical and Biological Agency Hospital №1 Russia. Extrapolating data from the pathomorphological study of deceased patients, who had a history of coronavirus infection and died from circulatory system diseases, on autopsy it was found that SARS-Cov-2 infection led to the development of subacute/chronic myocarditis. Its clinical manifestations develop within 4-6 months or more than a year after acute COVID-19 in the form of myocardial infarction or progressive heart failure. The researchers also emphasize the extreme importance of performing autopsy studies of any nosology in combination with COVID-19, for subsequent clinical and morphological analysis, which provide invaluable opportunities to summarize each morphological manifestation of this infection to be further compared to clinical manifestations. Thus, at present, any unclear myocardial dysfunction requires serodiagnosis of a new coronavirus infection. SARS-Cov-2 infection can cause chronic nonbacterial lymphocytic thromboendocarditis with an autoimmune mechanism; as well as its combination with lymphocytic myocarditis. Research in this field still needs to be continued.

​Circulating Cytokines in Myocardial Infarction Are Associated With Coronary Blood Flow.

BackgroundThe level of systemic inflammation correlates with the severity of the clinical course of acute myocardial infarction (AMI). It has been shown that circulating cytokines and endothelial dysfunction play an important role in the process of clot formation. The aim of our study was to assess the concentration of various circulating cytokines, endothelial function and blood clotting in AMI patients depending on the blood flow through the infarction-related artery (IRA).MethodsWe included 75 patients with AMI. 58 presented with ST-elevation myocardial infarction (STEMI) and 17 had non-ST-elevation myocardial infarction (non-STEMI). A flow-mediated dilation test (FMD test), thrombodynamics and rotational thromboelastometry as well as assessment of 14 serum cytokines using xMAP technology were performed.FindingsNon-STEMI-patients were characterized by higher levels of MDC, MIP-1β, TNF-α. Moreover, we observed that patients with impaired blood flow through the IRA (TIMI flow 0-1) had higher average and initial clot growth rates, earlier onset of spontaneous clots, C-reactive protein (CRP) and IL-10 compared to patients with preserved blood flow through the IRA (TIMI flow 2-3). Patients with TIMI 2-3 blood flow had higher level of IP-10. IL-10 correlated with CRP and pro-inflammatory cytokines levels, initial clot growth rate and clot lysis time in TIMI 0-1 patients. All these differences were statistically significant.InterpretationWe demonstrated that concentrations of the inflammatory cytokines correlate not only with the form of myocardial infarction (STEMI or non-STEMI), but also with the blood flow through the infarct-related artery. Inflammatory response, functional state of endothelium, and clot formation are closely linked with each other. A combination of these parameters affects the patency of the infarct-related artery.

Electrocardiographic Features of Patients with COVID-19: An Updated Review.

Numerous systemic manifestations, including cardiac involvement in the form of myocardial infarction, myocarditis, and electrocardiographic changes, have been associated with COVID-19..In this review, the authors describe the electrocardiographic features that have been reported to date in patients affected by this disease and their possible underlying mechanisms.

Diagnostics and management of patients with type 2 myocardial infarction

Myocardial infarction (MI) is an acute myocardial injury (confirmed by increasing|decreasing of cardiac troponin T and/or I) in conditions of proven acute myocardial ischemia, manifested by clinical symptoms of acute ischemia and/or ischemic changes on the ECG. Type 2 MI is a form of MI that is not associated with coronary atherothrombosis, secondary to a condition that results in an imbalance between myocardial oxygen intake and oxygen consumption. Type 2 MI can be caused by coronary artery spasm, coronary microvascular dysfunction, embolism, dissection of coronary arteries, aorta, bradyarrhythmia, tachyarrhythmia, respiratory failure with severe hypoxemia, anemia, blood loss, hypotension/shock of other etiology, severe hypertension, surgical interventions. Type 2 MI accounts for 270% of all cases of MI. More often type 2 MI occurs in women, elderly, severe, comorbid patients. Type 2 MI is ST segment elevation MI in 324% of patients and non-ST elevation MI in others. Coronary angiography (and autopsy) in type 2 MI reveals coronary atherosclerosis in 2590%, but there is no coronary artery thrombosis. Mortality in patients with type 2 MI is generally higher than in patients with type 1 MI. This article is devoted to the problem of diagnosis and management of patients with type 2 myocardial infarction.

Сhanges in the quality of life of patients undergoing coronary stenting and with concomitant pathology

Goal — was to assess the quality of life of patients with coronary heart disease, concomitant type II diabetes mellitus and arterial hypertension at 2 years after coronary stenting. Material and methods. The study included 103 patients aged 44 to 67 years. Clinical and laboratory results were assessed after stenting of the coronary arteries, 2 years later in an outpatient setting. The patients were divided into two groups: the 1st group included 54 patients with ischemic heart disease, angina pectoris III–IV f.c. in combination with arterial hypertension; in the 2nd group — 49 patients with ischemic heart disease, angina pectoris III–IV f.k. in combination with arterial hypertension and type II diabetes mellitus. The study was carried out in accordance with Good Clinical Practice and Declaration of Helsinki principles. The study protocol was approved by the Ethics Committees of all participating clinical centers. Written informed consent was obtained from all participants prior to enrollment.Results. In our study, 103 patients with ischemic heart disease and angina pectoris III–IV f.c. Within 2 years after coronary artery stenting, 33 cases of myocardial infarction (32.0%) were registered. The quality of life improved to stable exertional angina pectoris I–II f.k. 34 patients (33.0%). At the same time, 39.8% did not change their quality of life. Myocardial infarction in the group with angina pectoris III–IV f.k. and arterial hypertension, developed in 12 (22.2%) patients, and in the group with angina pectoris III–IV f.c. and arterial hypertension + type II diabetes mellitus were registered in 21 (42.8%) patients, which is almost twice as high as in group 1, the same for improving the quality of life. That is, despite the stenting of the coronary arteries, the high incidence of complications in the form of myocardial infarction can be explained by a combination of concomitant diseases, in the form of arterial hypertension + type II diabetes mellitus. We are confident that type II diabetes mellitus has a greater impact on the quality of life and complications in patients who have undergone coronary stenting. At the same time, the risk of complications decreases with adequate control of arterial hypertension and type II diabetes mellitus — the transition of angina pectoris III–IV to I–II f.c. characterized by a significant improvement at p-0.0034; odds ratio 0.50; the confidence interval is 0.31–0.80. Conclusion. The improvement in the quality of life in patients with coronary heart disease and arterial hypertension after stenting of the coronary arteries in the long-term period is twice as good as in patients with coronary heart disease and arterial hypertension + type II diabetes mellitus. Arterial hypertension is a serious but manageable risk factor for the development of macrovascular and microvascular complications. The study demonstrated the effectiveness of correcting only arterial hypertension in terms of preventing cardiovascular and microvascular complications than the combination of arterial hypertension and type II diabetes mellitus, which significantly worsen the prognosis of the disease in patients with coronary artery disease after coronary artery stenting. This is reflected in the recommendations for stratification of the risk of arterial hypertension and type II diabetes mellitus.

Казуистические маски инфаркта миокарда: постинфекционный, сепсис-ассоциированный

Целью обзора является представление хронологической последовательности действий при разработке универсальных дефиниций инфаркта миокарда, новых идей для улучшения скрининга постинфекционного и сепсис-ассоциированного инфаркта миокарда — казуистических масок инфаркта миокарда. Очерчены этапы разработки общего и всемирного определения инфаркта миокарда: 1 — рабочими группами ВОЗ на основе электрокардиографии для эпидемиологических исследований; 2 — совместно Европейским обществом кардиологов и Американским колледжем кардиологов с использованием клинического и биохимического подходов; 3 — создание Глобальной целевой группой консенсусного документа универсального определения с последующей классификацией инфаркта миокарда на пять подтипов (спонтанный; диссонанс в доставке и потреблении кислорода; летальный исход до подъема специфических маркеров повреждения миокарда; ассоциированный с чрескожным коронарным вмешательством; ассоциированный с аортокоронарным шунтированием); 4 — пересмотр объединенной целевой группой указанного выше документа на основе включения в него более чувствительных маркеров — тропонинов; 5 — выделение 17 неишемических повреждений миокарда, сопровождающихся повышением уровня тропонина; 6 — характеристика предсердного натрийуретического пептида с позиций его синтеза, хранения, высвобождения, диагностической значимости как биомаркера острого повреждения миокарда; 7 — клиническое определение инфаркта миокарда, представленное в материалах III Консенсуса по инфаркту миокарда 2017 года. Постановка диагноза инфаркта миокарда с использованием критериев, изложенных в этом документе, требует интеграции клинических данных, паттернов электрокардиографии, лабораторных данных, наблюдений визуализации и в отдельных случаях — патологических результатов, которые рассматриваются в контексте временного горизонта, под которым подозреваемое событие разворачивается. K. Thygesen et al. рассматривают дополнительное использование: сердечно-сосудистого магнитного резонанса для определения этиологии повреждения миокарда; компьютерной коронарной ангиографии при подозрении на инфаркт миокарда. Инфаркт миокарда — это сочетание специфических кардиомаркеров с хотя бы одним из признаков, приведенных выше. Формирование инфаркта миокарда происходит и при/после острой инфекции дыхательных путей. Установлены причинно-следственные связи между этими двумя состояниями. Постинфекционный инфаркт миокарда настоятельно рекомендуется индивидуализировать как отдельную нозологическую единицу. При сепсисе глобальная миокардиальная ишемия и в итоге ишемическое повреждение миокарда возникают в результате гуморальных и клеточных факторов, сопровождаются повышением уровня тропонинов, снижением фракции выброса левого желудочка на 45 % и увеличением конечных диастолических размеров левого желудочка, развитием сепсис-ассоциированного синдрома полиорганной недостаточности, что является неблагоприятным фактором прогноза.

Predicting cardiovascular events with deep learning approach in the context of the internet of things

Nowadays, one of the causes leading to death in all over the world is the occurrence of arterial and cardiovascular events, which results in heart failure and premature deaths occurring in the form of myocardial infarction, stroke, and fainting. Therefore, it is essential to inform people before disasters occurring to prevent and warn of abnormal conditions. In this paper, a deep learning approach was used to predict arterial events over the course of a few weeks/months prior to the event using a 5-min electrocardiogram (ECG) recording and extracting time–frequency features of ECG signals. Considering the possibility of learning long-term dependencies to identify and prevent these events as quickly as possible, the Long Short-Term Memory (LSTM) neural network was used. A Deep Belief Network (DBN) was also used to represent and select more efficient and effective features of the recorded dataset. This approach is briefly called LSTM-DBN. Four publicly available datasets in the field of health care were used to evaluate the proposed approach. These data were collected from wearable heart rate monitoring sensors along with demographic features in the context of the Internet of Things. The prediction results of the proposed LSTM-DBN were compared with other deep learning approaches (simple RNN, GRU, CNN and Ensemble), and traditional classification approaches (MLP, SVM, Logistic Regression and Random Forest). In addition, DBN performance was compared with other methods of feature selection and representation such as PCA and AutoEncoder. Experimental results showed that the proposed LSTM-DBN (88.42% mean accuracy) had significantly better performance in comparison with all other deep learning approaches and traditional classifications.

Karakteristike i lečenje koagulopatije udružene sa COVID-19

Coagulopathy in COVID-19 represents a thrombo-inflammatory condition, and it is one of the most important causes of morbidity and mortality in this disease. The occurrence of coagulopathy correlates with the intensity of the inflammatory response to SARS-Cov-2 virus infection, and its presence is characterized by laboratory markers of blood hypercoagulability and clinically pronounced prothrombotic condition. Although the mechanism of coagulopathy is not fully elucidated, dysregulated and overemphasized immune responses mediated by inflammatory cytokines, complement activation, leukocyte activation with release of free nucleic acids and histones into the circulation, hypoxia and endothelial damage play a very important role in its development. Thrombosis can occur in all parts of the circulatory system and is most often localized in the microcirculation and venous part of the vasculature. A number of studies have shown that the presence of thrombotic pulmonary embolism can be demonstrated by objective methods in approximately 15% of COVID-19 patients treated in intensive care units, while the incidence of total venous thromboembolism in this group of patients is over 20% despite antithrombotic prophylaxis. Although much less common than venous thrombosis, arterial thrombosis may also occur in COVID-19 patients, most often in the form of myocardial infarction, ischemic stroke and peripheral artery occlusion. Damage to the endothelium under the influence of virus or inflammatory response, activation of platelets and coagulation system with fibrin deposition leads to extensive thrombosis in the microcirculation of lungs and other tissues and directly contributes to respiratory failure, ARDS or multiorgan failure. Therefore, coagulopathy in COVID-19 is an integral part of the pathophysiological mechanism of the disease and contributes to its clinical manifestation and progression. Main laboratory characteristics of COVID-19 coagulopathy are elevated values of D-dimer in the blood, which occurs in the process of decomposition of precipitated fibrin under the action of fibrinolytic enzymes in the microcirculation of the lungs and other organs. Therefore, D-dimer values reflect the intensity of the inflammation in the lungs and have prognostic significance in recognizing patients at risk of serious complications and unfavorable course of the disease. In contrast to disseminated intravascular coagulation in sepsis, severe thrombocytopenia and hypofibrinogenemia as well as bleeding tendencies are rare in COVID-19 coagulopathy. Due to the high frequency and important role of coagulopathy in morbidity and mortality, the use of anticoagulant therapy is recommended in all hospitalized patients. However, the optimal way of treating coagulopathy and the intensity of antithrombotic prophylaxis are not known, and represent the subject of intensive research.

Methods of decreasing the risk of repeat interventions in patients after arterial revascularization

Discussed in the article are the main problems related to surgical treatment of patients with peripheral artery disease, particularly taking into consideration that in the world there are from 160 to 202 million people suffering from this disease, with two thirds of such patients having signs of lesions of coronary or cerebral arteries. Vascular reconstructive interventions cannot completely eliminate the problem, since in the postoperative period there may develop cardiovascular complications related to both the limb involved as either acute or progressing chronic ischaemia and arteries of other localization (coronary, cerebral). The risk of serious cardiovascular complications in patients with a history of endured adverse ischaemic events on the part of limbs is severalfold higher. To solve these problems and decrease complications, salicylic acid is used as basic therapy. Attempts at replacing it by another drug or combined therapy with an alternative antiaggregant showed no advantages in increased risk of massive haemorrhage. On the other hand, a combination of salicylic acid with an anticoagulant at a low dose, i. e., rivaroxaban 2.5 mg twice daily as compared with acetylsalicylic acid monotherapy made it possible to significantly decrease the incidence of various cardiovascular complications in the form of myocardial infarction, stroke, adverse ischaemic events on the part of the extremity, limb amputation.

Abstract 15859: Fibroblast Growth Factor 23 and Myocardial Infarction in the Boston Puerto Rican Health Study

Background: FGF-23 is an endocrine regulator of phosphate metabolism as well as also a potent biomarker that mediates cardiovascular remodeling, with markedly elevated plasma concentration associated with the occurrence of morbid cardiovascular events such as myocardial infarction. This association usually indicates risk of developing further adverse cardiovascular events in individuals that are already susceptible to repeat morbid cardiovascular outcomes. This cross-sectional epidemiological study aims at investigating the risk association between FGF-23 and individuals in the 8 th year cohort of the Boston Puerto Rican Health Study (BPRHS) that have self-reported clinical cardiovascular disease in the form of myocardial infarction. Methods: FGF-23 plasma concentration was measured by ELISA in 496 participants of the fourth wave of the Boston Puerto Rican Health Study (BPRHS). Multivariate logistic regressions were used to analyze the cross-sectional association of plasma FGF-23 quartile distribution with self-reported clinical diagnosis of myocardial infarction (MI). Results: The crude model for the association between FGF-23 and MI showed increased risk across the 2 nd , 3 rd and 4 th quartiles, OR (95% CI); 1.27 (0.48-3.34), 1.13 (0.42-3.04), and 3.13 (1.33-7.33), respectively. The relationship with the highest vs lowest quartile remained significant after adjusting for age, sex and BMI, OR (95% CI); 2.91 (1.15-7.36). With further adjustment for diabetes, smoking, plasma total cholesterol, HDL cholesterol and triglycerides, results were attenuated, and the latter comparison was no longer statistically significant, OR (95% CI); 2.15 (0.79-5.79). The test for trend across the quartiles yielded a p value of 0.03. Conclusion: Within this population of older Puerto Rican adults, FGF-23 was not significantly associated with increased likelihood of self-reported history of myocardial infarction. Longitudinal studies, using clinical parameters that objectively measure the progression of cardiovascular disease are needed to assess the prognostic value of FGF-23 for future cardiovascular outcomes.

Investigation of the Therapeutic Effects of Hot Springs Waters Sourced from Afyonkarahisar Region on Experimentally-induced Myocardial infarctus in Rats

Myocardial infarction is an important public health problem in human and animals. In this study, myocardial infarction was induced by intraperitoneally injected isoproterenol hydrochloride in saline solution at a dose of 85 mg/kg body weight for 2 days. After myocardial infarction formation, three animals were exed to collect blood and histopathological specimens. The remaining 32 rats were divided into control and study groups for treatment. In the treatment stage; the control group animals were treated with tap water, while the study group animals were received Süreyya I hot spring mineral water. Clinical, hematological, blood biochemical and histopathological examinations was performed in all the animals before study, after myocardial infarction, and on 1st, 7th, 14th and 21st days after treatment. In terms of T, P and R, there were significant differences (p <0.05) with respect to time periods between control and study groups (p <0.05). WBC, NOTR, MON MCH, HCT ve MCV levels decreased, while RBC, HG, HCT, LENF, MCH and MCHC levels increased following treatmen in both groups. These changes were significant in study group comaper to control. It was also seen that ALT, AST, CK and CRP levels of blood biochemical parameters were significantly increased (p <0.05) after myocardial infarction formation. By begining treatment, TP, ALB and GLU levels increased, whereas ALT, AST, CK and CRP levels decreased, especially on the 21st day of the study in the SG. It was concluded that in the correct temperature and time to use Süreyya I hot spring water as drinking and bathing was very successful in the treatment of myocardial infarction, either itself or along with other medical treatments.

Mechanisms of myocardial infarction with nonobstructive coronary atherosclerosis: a multifaceted play of different actors with guarded prognosis.

Myocardial infarction (MI) with nonobstructive coronary atherosclerosis (MINOCA) on invasive angiography (stenosis severity <50%) is a heterogenous clinical entity with a prevalence between 6 and 8% of all MI. Whereas the long-term prognosis of MINOCA is not benign, the identification of its underlying mechanism is critical for appropriate risk stratification and tailored secondary prevention strategies. The current review summarizes the contemporary data on the mechanisms, diagnosis, management strategies and outcomes of MINOCA. MINOCA is a relatively common form of MI with guarded prognosis. The use of additional diagnostic tests (particularly intracoronary imaging and cardiac magnetic resonance) is paramount to determine the exact cause of MINOCA and implement tailored medical interventions.

Obesity in Relationship with Different Forms of Myocardial Infarction (Data of Registry on Acute Myocardial Infarction)

In today’s world, the growth of technical progress has increased the number of people with obesity, which is one of the main risk factors for the development of acute myocardial infarction (MI). Objective: To evaluate the effect of obesity on some clinical and anthropometric characteristics in patients with acute MI. Material and Methods: A special questionnaire – a “registry card” was developed for monitoring patients with acute MI and collecting the necessary and complete information from employees of the Cardiovascular Diseases (CVD) Prevention Department. The presented article describes the data of a preliminary analysis of patients with acute MI treated in the clinic. Of the 202 people, 191 (94.6%) had a body mass index (BMI) calculated. Depending on the level of BMI, three groups were selected: 1 g (BMI &lt; 25 kg/m2) – 36 (18.8% of 191) patients with acute MI with normal weight (control group); 2 g (BMI = 25–30 kg/m2) – 84 (44.0% of 191) overweight people; 3 g (BMI &gt; 30 kg/m2) – 71 (37.2% of 191) people with obesity. Differences were considered significant at p &lt; 0.05. Results: Despite the fact that acute MI developed in women 2.6 times less frequently and 8.7 years later in age than in men, nevertheless, obesity in women was recorded more often, while in men overweight prevailed. In acute MI between the age of the respondents and the presence of increased weight, an inverse relationship was revealed (p &gt; 0.05), i.e., as the weight category increased, the age of the patients decreased. In patients with MI, as the weight increased, there was an increase in comorbid pathology, especially associated with impaired carbohydrate metabolism (p &lt; 0.0001). A more severe form of MI (STEMI) was more often recorded in persons with a BMI &gt; 25 kg/m2, while the front wall was the most vulnerable to the development of acute MI, regardless of the weight category of patients. The back wall was involved in the pathological process both in individuals with overweight and in patients with obesity. The apical segment in the largest number of cases was only affected in people with obesity. Conclusion: Obesity is a kind of epidemic of modern society. Its effects on the quality of life, prognosis, and effectiveness of conservative or minimally invasive treatment methods in patients with acute cardiovascular catastrophes, such as acute MI, are still a very controversial issue that requires furthermore in-depth study and analysis.

The comparison of revalcularization outcomes in acute coronary syndrom following primary coronary angioplasty

Purpose. To compare clinical and morphofunctional outcomes of revascularization in patients after primary coronary angioplasty with different degree of coronary arteries damage and type of myocardial infarction.&#x0D; Material and methods. The research involved 258 patients after myocardial infarction who underwent coronary balloon angioplasty with stenting infarct-related artery. By electrocardiographic and angiographic picture all patients were divided into 4 groups: Q-wave myocardial infarction and without Q-wave myocardial infarction with single-vessel and multivessel disease.&#x0D; Results. The study found that the patients with non Q-wave myocardial infarction and single-vessel disease had no adverse clinical outcomes during a year. The wall motion index and the ejection fraction almost recovered completely (wall motion index varied from 1.18 0.02 to 1.05 0.02 and ejection fraction from 57.4 0.5% to 63.3 0.6%; р 0.001). All the patients with Q-wave myocardial infarction revealed similar clinical outcomes and morphofunctional characteristics. The group of patients with non Q-wave and multivessel disease had the highest rate of adverse clinical outcomes with progressing left-ventricular disfunction according to echocardiography (wall motion index varied from 1.15 0.01 to 1.19 0.04 and ejection fraction from 53.9 0.5% to 55.1 0.6%; р 0.001).&#x0D; Conclusion. The degree of coronary arteries damage in the patients with Q myocardial infarction did not influence postinfarction remodeling and long-term cardiac outcomes. The patients with non-Q myocardial infarction and single-vessel disease had fewer signs of postinfarction remodeling and complications in postinfarction period. The worst prognosis was revealed by patients with similar forms of myocardial infarction and multivessel disease.

Association of Factor II G20210A, Factor V G1691A and methylenetetrahydrofolate reductase C677T gene polymorphism with different forms of myocardial infarction: ST segment elevation and non-ST segment elevation

Background/Aim. Coagulation Factor II G20210A and Factor V G1691A variants are moderately associated with coronary artery disease. Polymorphism of methylenetetrahydrofolate reductase (MTHFR) gene C677T is associated with myocardial infarction (MI) in some ethnical groups. At the present time there are rare studies which try to differentiate two forms of MI, ST-elevation MI (STEMI) and non ST-elevation MI (NSTEMI) according to the genetic background. The aim of the study was investigate the association of polymorphisms of Factor II G20210A, Factor V G1691A and MTHFR C677T with different forms of MI: STEMI and NSTEMI. Methods. The study included 82 patients, divided into two cohorts: patients with STEMI (49 patients) and NSTEMI (33 patients). Genetic factors that would be different in those two entities, included in response to plaque rupture and occlusion of coronary artery, were examined. The peripheral blood lymphocytes were used as DNA source. Genotypes were determined on the polymerase chain reaction (PCR) based methodology. Results. The frequency of MTHFR C677T CT genotype was higher in the patients with NSTEMI in comparison with the patients with STEMI [odds ratio (OR) 3.33; 95% confidence interval (CI) 1.22?9.15; p = 0.02]. Logistic regression analysis shows MTHFR CT genotype as an independent prognostic factor for development of NSTEMI (OR 3.15; 95% CI 1.20?8.29; p = 0.02). There were no differences between two patients groups in frequency of Factor II G20210A and Factor V G1691A gene polymorphism. Conclusion. MTHFR C677T CT genotype was significantly associated with the NSTEMI development examined patients.

Myocardial infarction with non-obstructive coronary arteries (MINOCA): diagnosis, pathogenesis, therapy and prognosis

The term MINOCA (myocardial infarction with non-obstructive coronary arteries) defines acute myocardial infarction with angiographic evidence of no significant coronary artery stenosis. Heterogeneous diseases are labelled as MINOCA. Incidence and epidemiological aspects differ on the basis of etiological causes. MINOCA include plaque (causing <50% stenosis) rupture or erosion, coronary embolism and dissection, and coronary artery spasm. Diagnosis may require multiple diagnostic tools, including cardiac imaging or provocative tests, in addition to standard coronary angiography, according to clinical suspicion. Cardiac magnetic resonance plays a key role in confirming the diagnosis and excluding other diseases with similar clinical presentation. Prognosis is not as benign as previously thought, on the opposite it is characterized by morbidity and mortality rates similar to other forms of myocardial infarction. Once the causative mechanism has been identified, appropriate therapy can be delivered.

Features of diagnosis and treatment of patients with stable coronary artery disease at initially normal arterial pressure

Of 875 patients being under the clinical follow-up at one of the polyclinics in Chelyabinsk, 216 (24.7%) had coronary artery disease (CAD) without arterial hypertension (AH) in past medical history. The authors conducted the comparative study of risk factors and clinical and instrumental features of the disease in 50 patients with isolated coronary artery disease and in 50 patients with coronary artery disease against the background of AH. It was found that the disease onset was more often manifested in the form of angina pectoris in patients with stable coronary artery disease without AG , and in the form of myocardial infarction in patients with CAD and AH. Pathological heredity, obesity, diabetes mellitus were more common in patients with the combination of CAD and AH. Stenosis of over 50% of at least one coronary artery is more often identified in patients with CAD and normal arterial pressure (AP). The full range of beta-blockers and calcium channel blockers may be prescribed to patients with CAD without AH in no more than 20% of cases due to excess drop in AP. The prescription of anti-ischemic drugs trimetazidine OD and ivabradine increased the CAD without AH, where these drugs probably should be referred to the first choice drugs.