Symptoms Of Myocardial Infarction Research Articles

Using the Apple Watch to Record Multiple-Lead Electrocardiograms in Detecting Myocardial Infarction: Where Are We Now?

Although the outcome after myocardial infarction depends on the time to treatment, a delay between symptom onset and treatment is common. Apple Watch, a popular wearable device, provides the ability to perform an electrocardiogram. We review the progress made in using the Apple Watch to record multiple electrocardiogram leads for diagnosing myocardial infarction. Although the data are encouraging, many limitations remain, and more research is needed. Nevertheless, the Apple Watch could eventually serve as a self-check tool for patients who have chest pains or other symptoms of myocardial infarction, thus substantially decreasing the time to treatment and improving the outcome after myocardial infarction.

Jujuboside A Ameliorates Myocardial Apoptosis and Inflammation in Rats with Coronary Heart Disease by Inhibiting PPAR-α Signaling Pathway.

Background Coronary heart disease (CHD) is a chronic disease caused by atherosclerosis (AS), which can cause myocardial ischemia, hypoxia, or necrosis, seriously threatening human health. There is an urgent need for effective treatments and drugs to reduce the various risk factors for coronary heart disease and relieve symptoms of angina pectoris and myocardial infarction in patients. Jujuboside A (JuA) is a triterpenoid saponin extracted from jujube seeds, which has various biological activities such as antioxidant, anti-inflammatory, antiapoptotic, and neuroprotective effects. We study the function of JuA in myocardial injury, dyslipidemia, and inflammation in the CHD rat model, to explore its potential mechanism of improving CHD. Methods A rat model of CHD was established by feeding a high-fat diet. The rats were randomly divided into 5 groups (n = 6): control group, CHD group, JuA 25 mg/kg group, JuA 50 mg/kg group, and JuA 75 mg/kg group. Echocardiography was used to detect the cardiac function parameters of rats in each group, and then, hematoxylin and eosin staining was used to assess the histopathological injury in myocardial tissues. Levels of blood lipids, myocardial injury indexes, and inflammatory factors of rats in each group were measured by biochemical tests and enzyme linked immunosorbent assay, and the levels of Bax, Bcl-2, c-caspase-3, PPAR-α, p65, p-p65, IκBα, and p-IκBα protein expression in myocardial tissues were detected by western blot. Results Compared with the CHD group, JuA therapy significantly improved injury in myocardial tissue and endothelial tissue. It also strengthened cardiac function, while decreasing total cholesterol, triacylglycerol, and low-density lipoprotein cholesterol levels in the serum and increasing high-density lipoprotein cholesterol levels. In addition, JuA also restrained cardiomyocytes apoptosis and inhibited the inflammatory reaction by reducing TNF-α, IL-1β, and IL-6 expression in myocardial tissues. Furthermore, administration of JuA inhibited the activation of PPAR-α pathway by preventing the phosphorylation of p65 and IκBα in myocardial tissues of CHD rats. Conclusion JuA may improve cardiac function, alleviate myocardial and endothelial injury, and also ameliorate dyslipidemia and inflammatory reaction in rats with CHD, where JuA probably plays a protective role by inhibiting the activation of PPAR-α pathway.

Knowledge of Symptoms of Acute Myocardial Infarction, Reaction to the Symptoms, and Ability to Perform Cardiopulmonary Resuscitation: Results From a Cross-sectional Survey in Four Regions in Germany.

BackgroundIschemic heart disease affects 126 million individuals globally which illustrates the importance of finding ways to decrease mortality and morbidity in case of an acute myocardial infarction (AMI). Since knowledge of symptoms, correct reaction to symptoms, and ability to perform cardiopulmonary resuscitation (CPR) decreases the time from symptoms-onset to reperfusion, which leads to lower AMI mortality, we aimed to examine those factors and identify predicting variables in regions with low and high AMI mortality rates.MethodsWe conducted a cross-sectional online survey including 633 respondents from the general population in four federal states in Germany with low and high AMI mortality and morbidity rates. We used uni- and multivariable regressions to find health-related and sociodemographic factors associated with knowledge, reaction to symptoms, and skills in CPR.ResultsOut of 11 symptoms, the mean of correctly attributed AMI symptoms was 7.3 (standard deviation 1.96). About 93% of respondents chose to call an ambulance when witnessing an AMI. However, when confronted with the description of a real-life situation, only 35 and 65% of the participants would call an ambulance in case of abdominal and chest pain, respectively. The predicting variables for higher knowledge were being female, knowing someone with heart disease, and being an ex-smoker compared to people who never smoked. Higher knowledge was associated with adequate reaction in the description of a real-life situation and ability to perform CPR. Prevalence ratio for being able to perform CPR was lower in females, older participants, and participants with low educational level. About 38% of participants state to know how to perform CPR. Our results indicate rather no difference regarding knowledge, reaction to AMI symptoms, and ability to perform CPR among different regions in Germany.ConclusionsKnowledge of symptoms and first responder reaction including skills in CPR is inadequate when confronted with the description of a real-life situation. Educational health campaigns should focus on conveying information close to real-life situations. Interventions for enhancing ability to perform CPR should be compulsory in regular intervals. Interestingly, we found no difference regarding the factors in regions with high and low AMI mortality rates in Germany.

A Contemporary Role of Beta Blockers in Myocardial Infarction

Myocardial infarction (MI) is characterized by plaque formation in the inner layer of arteries which occurs due to insufficient or complete cessation of oxygen supply in the myocardium. The common symptoms of MI are crushing or squeezing chest pain which radiates to the arms, shoulders, neck, or jaw, nausea, anxiety, restlessness, fear, heartburn, shortness of breath, cold sweat, fatigue, and dizziness. The treatment of this medical condition includes antiplatelet and thrombolytic therapy, painkillers (morphine or meperidine), diuretics and digitalis glycosides drugs. Moreover, nitroglycerin and antihypertensive drugs such as Beta-blockers, ACE inhibitors, or Calcium channel blockers may also be administered to reduce the blood pressure and improve the oxygen supply in the heart. Among them, beta blocker therapy has several beneficial properties such as it reduces myocardial oxygen demand, preventing arrhythmias, and improves ventricular remodeling, etc. However, there is no study on the role of only beta blocker therapy in the survival of MI patent is found to date. Thus, the present study focused on the evidence-based validation of Beta blocker therapy in the treatment and survival of MI patients. The retrospective study was conducted on 51 MI patients under the observation of medical practitioners. 100% of patients with MI showed a good recovery as well as survival percentage with Beta blocker therapy. This study finally concluded that beta blocker therapy is a safe and effective treatment for MI patients with negligible life-threatening medical conditions. Furthermore, a large group study is suggested with a number of health-related parameters for a better understanding of beta blocker as a first line of treatment for MI patients.

Eversion Carotid Endarterectomy: Cardiac Troponin Assessment.

Myocardial infarction (MI) is an eversion carotid endarterectomy (eCEA) complication, but most events are unknown, and true incidence and correlation remain controversial. Routine cardiac troponin measurement is a commonly used method for assessing early identification and treatment of MI and stratifying high-risk patients. The aim of the present study is to evaluate the effect of troponin elevation levels following eCEA and to investigate a possible correlation between adverse cardiovascular events and the incidence of postoperative myocardial infarction following emergent vascular surgery. The study included 54 patients who underwent eCEA. High-sensitive troponin I (hsTnI) levels were routinely monitored pre- and postoperatively, with an upper reference range of 34.5 pg/mL for men and 15.6 pg/mL for women. Increases were correlated with demographic and clinical risk factors, as well as clinical or subclinical cardiovascular events. hsTnI was increased in percentage (13%) postoperatively, and non-ST segment elevation MI was diagnosed in eight patients. No patient had clinical symptoms of MI and only two of them presented with simultaneous electrocardiographic changes. Increased levels did not correlate with comorbidities or other surgical risk factors. hsTnI elevation may occur in patients after eCEA and mostly correlates with silent non-ST segment elevation MI that occurred in the early postoperative phase, indicating a possible value as a tool for cardiovascular event diagnosis during the patient's hospitalization.

Changes in the lipidogram and hemostasis system in elderly patients with myocardial infarction, hypertension depending on the severity of senile asthenia syndrome

Background. The development of myocardial infarction (MI) is associated with the lipid and hemostatic disorders, which are not fully investigated in patients with senile asthenia syndrome (SAS).Objective. To analyze changes in the lipidogram and hemostasis system in elderly patients with MI, hypertension (HTN), depending on the severity of SAS.Design and methods. Indicators of lipid metabolism and hemostasis system were studied in patients aged 60–74 years with MI, grade 1–2 HTN (n = 80); 60–74 years with MI, grade 1–2 HTN with senile preasthenia (SP); 60–74 years with MI, grade 1–2 HTN and SAS in the period from 2 to 4 days after MI onset. The diagnosis of MI without ST segment elevation was established based on the criteria of the European Society of Cardiology, HTN was diagnosed in accordance with the “National Recommendations of the All-Russian Scientific Society of Cardiology”, SAS — according to the criteria of L.P. Fried. The study of lipid metabolism indicators performed on the analyzer “KoneLab 300” and “PersonalLab”, hemostasis systems — with the use of reagents “Technology Standard”.Results. In elderly patients with MI, HTN and SP, the level of triglycerides is significantly higher compared to those without senile asthenia (1,8 ± 0,04 vs. 1,4 ± 0,03 mmol/l), low-density lipoproteins (4,2 ± 0,07 vs. 3,6 ± 0,05 mmol/l), antithrombin III activity (105,8 ± 2,2 vs. 97,4 ± 2,3%), plasminogen activator inhibitor (291,5 ± 3,8 vs. 275,2 ± 3,6 ng/ml). With the progression of senile transformation into SAS, these changes in patients 60–74 years old with MI, HTN are aggravated, and especially changes in apoliprotein-A1, leptin, very low density lipoproteins, fibrinogen, plasminogen activator inhibitor, in globulin-dependent fibrinolysis, which indicates a negative effect of SAS on lipidogram and hemostasis indicators.Conclusions. The changes in lipidogram and hemostasis indicators should be taken into account in the management of elderly patients with MI, HTN and SAS symptoms, they should be also considered as predictors of the MI outcomes.

Masters age football and cardiovascular risk.

Football (soccer) is popular among those of Masters age (≥35 years). Although regular exercise improves health, strenuous exercise causes a transient increase in cardiac risk. To gain insight into cardiac risk factors, symptoms, and knowledge, attitudes and beliefs about myocardial infarction (MI), and support for prevention. A web-based survey using REDCap was completed by 153 amateur Masters footballers from A grade competition (n = 24), B or lower grade (n = 95) or social games (n = 34) in Sydney, Australia. Participants were aged 49.3 ± 7.5 years and primarily male (92.2%), Caucasian (88.9%) and university educated (75.2%). Risk factors included hypercholesterolaemia (37.3%), hypertension (19.6%), smoker (7.8%), overweight (40.5%) or obese (13.1%). One-fifth (21.6%) reported ≥1 potential cardiac symptom during activity in the prior year, for which one-quarter (24.2%) sought medical attention. Knowledge of typical MI symptoms was high (>80%) but lower (<40%) for less typical symptoms. Half (49.6%) were not confident to recognise MI in themselves. Half (49.0%) would remain on the field for 5-10 min with chest pain. Only 39.9% were aware that warning signs might precede MI by days. They overestimated survival from cardiac arrest (43%). Participants supported training in automatic external defibrillators (AED) and cardiopulmonary resuscitation (84%), AED at games (85%) and cardiac education (>70%). Cardiac risk factors are common In Masters footballers, with one in five experiencing possible cardiac symptoms in the prior year. While gaps exist in knowledge and optimal responses, strong support exists for preventive measures.

Abstract TP203: Predictors Of Alzheimer's Disease And Related Dementias Among Older Adults

Introduction: Alzheimer’s disease and related dementias (ADRD) are a leading cause of disability and premature death in the U.S. The aim of this study was to identify demographic and clinical predictors (age, sex race/ ethnicity, marital status, education level, history of heart disease, myocardial infarction, stroke, hypertension, diabetes, anxiety and depression symptoms, subjective memory rating, clock drawing results) of ADRD in a cohort of adults over age 65. Methods: We obtained data for 2011 to 2020 from the National Health and Aging Trends Study (NHATS). NHATS contains a nationally representative sample of Medicare beneficiaries aged 65 years and older. We included participants with complete data (N=6161). Results: Logistic regression analysis (see Table 1) suggested that the odds of having ADRD were 2.24 times higher in participants who had a stroke than in those who had not (p&lt;0.001). The odds of having ADRD were 45% less among Black individuals than among White individuals (p=0.02). Participants ≥75 years old had higher odds of ADRD than those &lt;70 years old (p&lt;0.001). Participants who experienced anxiety symptoms “nearly every day” were more likely to have ADRD than those who did not experience anxiety symptoms (p=0.04). Those rating their memory as fair or poor were more likely to have ADRD (p&lt;0.001). Those with clock drawing results that were reasonably accurate or accurate were less likely to have ADRD than those with clocks that were unrecognizable (p=.03). The area under receiver operator curve for the regression model was 0.887. Conclusions: Our study findings that participants with a history of stroke, anxiety symptoms, and a poor memory self-rating were at higher risk for ADRD and those with accurate clock drawing tests were at lower risk for ADRD are consistent with prior studies. However, our finding that Blacks were at lower risk for ADRD is inconsistent with prior studies which suggests that additional research is needed.

Co-Designing a Program to Lower Cardiovascular Disease Risk in Midlife Black Women.

Midlife Black women suffer disproportionately from heart disease and stroke in comparison to White women of similar age and demographic. Risk for cardiovascular disease (CVD) and stroke is largely considered to be modifiable yet CVD prevention and awareness campaigns have been less effective among Black women. Decreased awareness of personal CVD risk is associated with delays in the presentation of women to the emergency room or health care providers for symptoms of myocardial infarction. The Midlife Black Women’s Stress and Wellness (B-SWELL) program was designed to increase awareness about CVD risk factors, stress, and healthy lifestyle behaviors among midlife Black women. In partnership with an existing Community Research Advisory Board (C-RAB), materials were developed and culturally adapted for the B-SWELL program. Following successful development of the B-SWELL materials, a trial of the B-SWELL program was conducted with a sample of midlife Black women recruited from the community. The program was co-facilitated by members of the C-RAB. We outline the strategies used to successfully co-create and trial the B-SWELL program materials and reflect on the strengths and challenges associated with the development of a culturally tailored heart disease prevention program using community participatory methods.

Myocardial Infarction

Myocardial infarction (MI), commonly known as a heart attack is the disease of the blood vessels supplying the heart muscle (Myocardium) i.e. coronary heart disease. The area of heart muscle that has either zero flow or so little flow that it cannot sustain cardiac muscle function is said to be infracted and the overall process is called a myocardial infarction. MI are of two types; transmural and subendocardial. Mainly it is caused due to oxidative stress and atherosclerosis.Chest pain is the most common symptom of acute MI and is often described as a sensation of tightness, pressure, or squeezing. Other symptoms include diaphoresis (an excessive form of sweating), Shortness of breath (dyspnea), weakness, light-headedness, nausea, vomiting, and palpitations. The most common symptoms of MI in women include dyspnea, weakness, and fatigue, sleep disturbances. It can be treated by using blockers, diuretics, ACE inhibitors, calcium channel blockers and nitrates.

T inversion myocardial infarction, non-obstructive coronary arteries and repeated chest stress and chest pain in a 64 year-old-woman

Myocardial infarction with non-obstructive coronary arteries (MINOCA), usually affect old women. It differs from infarction with obstructive coronary arteries in that it is not frequently associated with hypertension, hyperlipidemia or diabetes. We present a case of MINOCA where electrocardiogram (ECG) acted as a parameter of evaluation of the severity of the condition. A 64-year-old woman presented with the symptoms of acute myocardial infarction. ECG showed T wave changes (T ⅱ, ⅲ, avF, V4-V6 inversion). Cardiac magnetic resonance (CMR) imaging confirmed the presence of myocardial ischemia of the inferior ventricular wall. T wave returned to normal on ECG examination after 1 month of follow up after a series of treatments.

The growing need for reliable online health information during lockdown in Europe: An infodemiologic analysis of myocardial infarction management in the COVID-19 era.

I n t r o d u c t i o n: The COVID-19 pandemic has put healthcare systems worldwide under huge strain, resulting in a significant loss of their capacity and availability. Patients have become more reluctant to contact their doctors or call an ambulance in case of myocardial infarction (MI) symptoms onset. It has been accompanied by a significant decrease in the number of coronary angiography and PCI procedures performed. O b j e c t i v e s: The aim of the study is to evaluate the role of online health information in the patient- dependent phase of MI management during the COVID-19 lockdown in Europe. Methods: We analyzed Google Trends data on the popularity of phrases related to MI symptoms, respiratory tract infection, urological complaints, and terms unrelated to health, for the period of the first COVID-19 lockdown, along with the data from the corresponding weeks from 2017-2019 in seven European countries. R e s u l t s: The search volume for particular symptoms of myocardial infarction increased in all studied countries, compared to the analogous period from 2017-2019, with a significant increase in for chest pain, shortness of breath, fear, and palpitations in most countries. These changes have not been accompanied by increased interest in terms related to respiratory tract infection symptoms and urological complaints. C o n c l u s i o n s: Our findings suggest that during lockdown, patients with MI symptoms may have tried to manage their complaints on their own, using information from the Internet. This demonstrates the growing role of the Internet in the patient's decision-making process in the emergency situation, indicating a growing need for reliable and freely available online information provided by healthcare professionals.

Assessment of Prevalent Risk Factors and Warning Signs and Symptoms among Myocardial Infarction Patients Attending Cardiology Department, Skims

Myocardial infarction (MI) is a challenging clinical and public health problem among older adults in the United States, and elderly patients often have an atypical clinical picture. There is gender difference in occurrence of symptoms, women reported more nausea and shortness of breath than men. The absence of typical clinical signs hinders the management of coronary heart disease. The study aims to assess prevalent risk factors and warning signs &amp; symptoms of MI patients and to find out difference in presentation of warning signs &amp; symptoms of MI as per their age and gender.A descriptive research design that involved total enumerative sampling technique to collect data from the 150 MI patients at Sher-i-Kashmir Institute of Medical Sciences, Kashmir, using a “self-structured interview schedule”. Results: The findings revealed that most of the study subjects were males i.e. (72.7%0 and majority were less than 60 years of age i.e. 55.3% .There was a significant age difference in symptom presentation for sudden pain in the chest(p=0.041), sudden discomfort in the chest(p=0.041)sudden tightness in the chest(p=0.039), sudden pressure in the chest(p=0.040) palpitation(p=0.041), chest pain radiating to jaw ( p=0.045 ), chest pain radiating to neck (p=0.05 ), epigastric pain (p=0.041), nausea,(p=0.041), vomiting (p=0.039), belching (p=0.040) , indigestion, (p=0.046 ), shortness of breath( p=0.040 ), faint (syncope),(p=0.049), sudden sleep disturbances(p=0.048), hot or cold sensations (p=0.047 ) .In gender, there was a significant gender difference with males showing for sudden pain in the chest(p=0.047), sudden discomfort in the chest (p=0.047)sudden tightness in the chest(p=0.047), and sudden pressure in the chest (p=0.047) vomiting (p=0.047). Conclusion: Majority of the patients were smokers, physically inactive. Warning signs and symptoms of MI are influenced by age and gender. Less than 60 years patients have higher odds for typical warning signs &amp; symptoms and more than 60 years have higher odds for atypical warning signs and symptoms of MI. Male patients have higher odds for typical signs and female patients have higher odds for atypical warning signs and symptoms of MI.

Commentary.

I have often said to interested trainees and students that vascular surgery is about women's health. Evidence suggests that cardiovascular disease affects women differently—the symptoms of myocardial infarction are often “atypical” in women. The number of hospital discharges for heart failure and stroke are higher in women than in men.1 When detected in women, abdominal aortic aneurysms are often anatomically unsuitable for commercially available endovascular devices, and mortality is higher from either open or endovascular surgery.

Community awareness of myocardial infarction in Bisha region, Saudi Arabia

Background: Early seeking medical advice can save the lives of many people in our community. This study aimed at assessing the community awareness of causes, risk factors, symptoms, and preventive measures of myocardial infarction (MI) in Bisha, Saudi Arabia. Also, to spread health culture regarding preventive measures and early seek of medical advice in our community. Methods: A descriptive community-based cross-sectional study was conducted in Bisha town in the southern region of Saudi Arabia. A total of 556 people have been selected randomly to participate in the study. Data were collected through the &amp;quot;Online Survey,&amp;quot; which contained eight questions that assessed the knowledge about MI among the community in Bisha, and feedback on their response was offered to correct the wrong answer and promote the right answers. Data analysis by Statistical Package for the Social Sciences version 23. Results: A total of 566 participants were included in this study. Regarding age, 360 (63.3.%) participants were 18-40 years old, while 206 (36.4%) were 41 years and older. Regarding gender, 291 (51.4%) of the participants were male, while 275 (48.6%) were female. 8 (1.4%) participants had a primary school education, 10 (1.8%) had intermediate school education, 91 (16.1%) had a high school education, 426 (75.3%) had a university education, and 31 (5.5%) had other levels of education. A significant association was observed between age and knowledge of MI (p = 0.025). Conclusion: This study&amp;apos;s outcome showed relatively limited knowledge of MI symptoms among the Bisha community.

The relationship between symptom onset-to-needle time and ischemic outcomes in patients with acute myocardial infarction treated with primary PCI: Observations from Prague-18 Study

ObjectivesBased on previous studies with clopidogrel, the time between acute myocardial infarction (AMI) symptoms onset and primary percutaneous coronary intervention (PCI) was proven as important prognostic factor. Our aim was to assess the relationship between symptoms onset to needle time (SNT) and procedural results and the occurrence of ischemic endpoints in primary angioplasty patients treated with potent P2Y12 inhibitors. MethodsA total of 1,131 out of 1,230 patients randomized to the Prague-18 study (prasugrel vs. ticagrelor in primary PCI) were divided into a high and a low-risk group. The effect of defined SNT on patients' ischemic endpoints and prognosis by their risk status at admission was tested. ResultsThe median SNT was 3.2 hours. Longer SNTs resulted in a more frequent incidence of TIMI flow <3 post PCI (p=0.015). There were significant differences in the occurrence of the combined ischemic endpoint among the compared SNT groups at 30 days (p=0.032), and 1 year (p=0.011), with the highest incidence in the ≤1 h SNT group of patients. "Latecomers" (SNT>4 hs) in the high-risk group experienced more reinfarction within 1 year [OR (95% CI) 3.23 (1.09–9.62) p=0.035]; no difference was found in the low-risk group. ConclusionsIn the era of intense antithrombotic medication, stratification of MI patients undergoing primary angioplasty, based on initial ischemic risk assessment affected prognosis more than symptom onset to needle time. Longer time delay was significantly related to increased incidence of ischemic events and all-cause mortality only in patients with high ischemic risk.

Symptoms of Acute Myocardial Infarction as Described in Calls to Tele-Nurses and in Questionnaires: A Mixed-Methods Study.

Patient-reported symptoms of acute myocardial infarction (MI) may be affected by recall bias depending on when and where symptoms are assessed. The aim of this study was to gain an understanding of patients' symptom description in more detail before and within 24 hours after a confirmed MI diagnosis. A convergent parallel mixed-methods design was used to examine symptoms described in calls between the tele-nurse and the patient compared with symptoms selected by the patient from a questionnaire less than 24 hours after hospital admission. Quantitative and qualitative data were analyzed separately and then merged into a final interpretation. Thirty patients (median age, 67.5 years; 20 men) were included. Chest pain was the most commonly reported symptom in questionnaires (24/30). Likewise, in 19 of 30 calls, chest pain was the first complaint mentioned, usually described together with the symptom onset. Expressions used to describe symptom quality were pain, pressure, discomfort, ache, cramp, tension, and soreness. Associated symptoms commonly described were pain or numbness in the arms, cold sweat, dyspnea, weakness, and nausea. Bodily sensations, such as feeling unwell or weak, were also described. Fear and tiredness were described in calls significantly less often than reported in questionnaires ( P = .01 and P = .02), whereas "other" symptoms were more often mentioned in calls compared with answers given in the questionnaire ( P = .02). Some symptoms expressed in the calls were not listed in the questionnaire, which expands the understanding of acute MI symptoms. The results showed no major inconsistencies between datasets. Patients' MI symptom descriptions in tele-calls and those reported in questionnaires after diagnosis are comparable and convergent.

Disparities in Awareness of Myocardial Infarction and Stroke Symptoms and Response Among United States- and Foreign-Born Adults in the National Health Interview Survey.

BackgroundAtherosclerotic cardiovascular disease, defined as nonfatal myocardial infarction (MI), coronary heart disease death, or fatal or nonfatal stroke, is the leading cause of death in the United States. MI and stroke symptom awareness and response reduce delays in hospitalization and mortality.Methods and ResultsWe analyzed cross‐sectional data from the 2014 and 2017 National Health Interview Surveys on US‐ and foreign‐born adults from 9 regions of birth (Europe, South America, Mexico/Central America/Caribbean, Russia, Africa, Middle East, Indian subcontinent, Asia, and Southeast Asia). The outcomes were recommended MI and stroke knowledge, defined as knowing all 5 symptoms of MI or stroke, respectively, and choosing “call 9‐1‐1” as the best response. We included 63 059 participants, with a mean age 49.4 years; 54.1% were women, and 38.5% had a high school education or less. Recommended MI and stroke knowledge were highest in US‐born people. In both 2014 and 2017, MI knowledge was lowest in individuals born in Asia (23.9%±2.5% and 32.1%±3.3%, respectively), and stroke knowledge lowest for the Indian subcontinent (44.4%±2.4% and 46.0%±3.2%, respectively). Among foreign‐born adults, people from Russia and Europe had the highest prevalence of recommended MI knowledge in 2014 (37.4%±5.4%) and 2017 (43.5%±2.5%), respectively, and recommended stroke knowledge was highest in people from Europe (61.0%±2.6% and 67.2%±2.5%). Improvement in knowledge was not significant in all groups between 2014 and 2017.ConclusionsThese findings suggest a disparity in MI and stroke symptom awareness and response among immigrants in the United States. Culturally tailored public health education and health literacy initiatives are needed to help reduce these disparities in awareness.

Abstract 13156: Acute Myocardial Infarction With Biventricular Thrombi Due to Blunt Thoracic Trauma

To our knowledge, this is the first ever reported case of biventricular thrombi with acutemyocardial infarction following blunt thoracic wall trauma. We present a case of a man who presented with non-ST segment elevation myocardial infarction with left anterior descending artery (LAD) occlusion and biventricular thrombi after a blunt thoracic wall trauma. Clinical Vignette: A 56-year-old man with past medical history of diabetes mellitus and hypothyroidism presented to our ED with dizziness after motor vehicle collision. Initial workup revealed biventricular thrombi, pulmonary embolus, and dural sinus thrombosis. 2D echocardiogram showed decreased systolic function with ejection fraction of 15% and enlargement of both ventricles with biventricular thrombi. Serial troponin I levels consistently elevated from 0.3 to 0.6. After initiating cangrelor and heparin infusion, patient underwent coronary angiography which revealed LAD occlusion with a thrombus. Patient then successfully underwent mechanical thrombectomy with restoration of TIMI grade III blood flow. Discussion: Hence, we presented the first ever reported case of biventricular thrombi with LAD occlusion resulting from blunt thoracic wall trauma. While trauma induced musculoskeletal pain may mask symptoms of myocardial infarction, a high index of suspicion for acute coronary syndrome can lead to desirable outcomes in such patients.

Sex Differences in Symptom Phenotypes Among Older Patients with Acute Myocardial Infarction

BackgroundClinicians make a medical diagnosis by recognizing diagnostic possibilities, often using memories of prior examples. These memories, called “exemplars,” reflect specific symptom combinations in individual patients, yet most clinical studies report how symptoms aggregate in populations. We studied how symptoms of acute myocardial infarction combine in individuals as symptom phenotypes and how symptom phenotypes are distributed in women and men. MethodsIn this analysis of the SILVER-AMI Study, we studied 3041 patients (1346 women and 1645 men) 75 years of age or older with acute myocardial infarction. Each patient had a standardized in-person interview during the acute myocardial infarction admission to document the presenting symptoms, which enabled a thorough examination of symptom combinations in individuals. Specific symptom combinations defined symptom phenotypes and distributions of symptom phenotypes were compared in women and men using Monte Carlo permutation testing and repeated subsampling. ResultsThere were 1469 unique symptom phenotypes in the entire SILVER-AMI cohort of patients with acute myocardial infarction. There were 831 unique symptom phenotypes in women, as compared with 819 in men, which was highly significant, given the larger number of men than women in the study (P < .0001). Women had significantly more symptom phenotypes than men in almost all acute myocardial infarction subgroups. ConclusionsOlder patients with acute myocardial infarction have enormous variation in symptom phenotypes. Women reported more symptoms and had significantly more symptom phenotypes than men. Appreciation of the diversity of symptom phenotypes may help clinicians recognize the less common phenotypes that occur more often in women.