Previous History Of Angina Pectoris Research Articles

ST elevation acute myocardial infarction in young versus elderly: An observational study

ABSTRACT Background: ST elevation acute myocardial infarction (AMI) is usually associated with marked morbidity and mortality, affecting both young and elderly populations. Aims: To compare the differences in clinical presentation, treatment, outcome, and comorbidity in elderly and young patients of ST elevation myocardial infarction (STEMI). Methods: A prospective study was conducted on 60 patients divided equally into two groups – above 60 years (Group A) and 60 years or below (Group B). The various parameters including clinical presentation, time of onset, type of AMI, medication, complications, and outcome were assessed. They were followed up for 1 month. Results: The proportion of males and females (M:F) was equal in Group A, and the M:F ratio was 2.75 in Group B. The mean duration of hospitalization was longer in elderly. Hypertension was the most common comorbid condition. About half of the elderly cohort had previous history of angina pectoris, and about one third had prior attacks of MI. Overall, a higher number of younger cohorts were thrombolyzed with streptokinase. Conclusion: Our study showed that there were noteworthy differences in clinical presentation, management, and outcome between elderly and young AMI patients. Early recognition of atypical features among elderly can lead to effective strategies and timely management.

The incidence of myocardial infarction in young people

Myocardial infarction (MI) occurs mainly in the population of middle-aged and elderly people, however, in recent years, the disease is increasingly developing in people under 45 years old, which, apparently, is associated with modern changes in lifestyle. Young men, smokers, people with a hereditary predisposition to the early development of cardiovascular pathology and having problems with employment are in the group at increased risk of early development of myocardial infarction. At a young age, the development of acute coronary syndrome with ST segment elevation on the electrocardiogram is most typical, which arose in patients without a previous history of angina pectoris. Rupture of the lining of atheroma as a cause of coronary thrombosis occurs in young people more often than erosion. Traditionally, in the pathogenesis of atherothrombosis, rupture of the atherosclerotic plaque cover is considered the key moment, which is more typical for atheroma with a large lipid core, thin cover and high inflammation activity. This plaque is traditionally called unstable. Tire erosion is more common in plaques with opposite characteristics and is more common in women and the elderly. Non-atherogenic causes of myocardial infarction at a young age can also be observed, for example, vasospasm, embolism in the coronary arteries in patients with endocarditis, etc. For the prognosis of the disease, it is important to assess the risk of complications, in particular, heart failure. It was found that young people have the lowest risk of its development.

Use of aspirin and bleeding-related complications after hepatic resection.

The operative risk of hepatectomy under antiplatelet therapy is unknown. This study sought to assess the outcomes of elective hepatectomy performed with or without aspirin continuation in a well balanced matched cohort. Data were retrieved from a multicentre prospective observational study. Aspirin and control groups were compared by non-standardized methods and by propensity score (PS) matching analysis. The main outcome was severe (Dindo-Clavien grade IIIa or more) haemorrhage. Other outcomes analysed were intraoperative transfusion, overall haemorrhage, major morbidity, comprehensive complication index (CCI) score, thromboembolic complications, ischaemic complications and mortality. Before matching, there were 118 patients in the aspirin group and 1685 in the control group. ASA fitness grade, cardiovascular disease, previous history of angina pectoris, angioplasty, diabetes, use of vitamin K antagonists, cirrhosis and type of hepatectomy were significantly different between the groups. After PS matching, 108 patients were included in each group. There were no statistically significant differences between the aspirin and control groups in severe haemorrhage (6·5 versus 5·6 per cent respectively; odds ratio (OR) 1·18, 95 per cent c.i. 0·38 to 3·62), intraoperative transfusion (23·4 versus 23·7 per cent; OR 0·98, 0·51 to 1·87), overall haemorrhage (10·2 versus 12·0 per cent; OR 0·83, 0·35 to 1·94), CCI score (24 versus 28; P = 0·520), major complications (23·1 versus 13·9 per cent; OR 1·82, 0·92 to 3·79) and 90-day mortality (5·6 versus 4·6 per cent; OR 1·21, 0·36 to 4·09). This observational study suggested that aspirin continuation is not associated with a higher rate of bleeding-related complications after elective hepatic surgery.

Robotic thoracic surgery of the left pleural cupula mediastinal mass.

Medical history: the patient, a 67-year-old women, was admitted due to “thoracic back pain accompanied with chest tightness and shortness of breath for over 5 months”. She suffered from thoracic back pain 5 months ago, which was accompanied with chest tightness and shortness of breath after physical activities. Chest CT displayed the presence of a mediastinal mass. She then visited our hospital for surgical treatment. She complained that she had a previous history of angina pectoris for 2 years, which had not received any formal diagnosis or treatment. She had no previous history of other conditions.

Coronary thrombi neovascularization in patients with ST-elevation myocardial infarction - clinical and angiographic implications

IntroductionCoronary artery thrombosis in ST-elevation myocardial infarction (STEMI) is a dynamic process often preceded by episodes of silent plaque rupture and subocclusive thrombosis. Thrombus organization is achieved by ingrowth of endothelial and smooth muscle cells. Clinical significance and impact of thrombus neovascularization on primary percutaneous coronary intervention (pPCI) outcome remain unclear. Therefore we investigated composition and neovascularization of thrombi aspirated during pPCI and their association with clinical and angiographic parameters of STEMI patients. MethodsAspirated thrombi retrieved from 84 STEMI patients were classified as fresh (<1day), lytic (1-5days) or organized (>5days). Thrombus neovascularization was evaluated immunohistochemically using CD34, CD31 and VEGF antibodies. CD34 and CD31 immunopositive (CD34/CD31+) cells were organized as single, clusters and microvessels. VEGF positivity was graded as low or high, based on thrombus surface immunopositive area. ResultsCD34/CD31+ cells were present in 67% of all aspirated thrombi. Thrombus CD34/CD31 positivity was associated with previous history of angina pectoris (χ2=6.142, p=0.013) and lower myocardial blush grade (MBG<3, χ2=12.602, p<0.001). Organization of CD34/CD31+ cells showed inverse association with the extent of VEGF positivity (χ2=10.607, p=0.005). Fresh thrombi were associated with shorter ischemic time (U=237.5, p=0.002) and MBG 3 (χ2=6.379, p=0.012). ConclusionsOlder thrombus age and neovascularization are associated with suboptimal myocardial perfusion in STEMI patients. Thrombus VEGF expression is inversely associated with degree of CD34+ cell organization. Therefore, neovascularization of aspirated thrombi may indicate the duration of thrombosis, coronary microcirculation status and outcome in STEMI patients.

Non-ST-Segment Elevation Myocardial Infarction in the Setting of Sexual Intercourse Following the Use of Cocaine and Sildenafil

Acute myocardial infarction (MI) in the setting of sexual intercourse following the concomitant use of cocaine, alcohol, and sildenafil has not been previously reported. We present a case of a middle-aged patient with no previous history of angina pectoris or coronary artery disease who presents with severe ischemic chest pain and an MI induced by cocaine, alcohol, sildenafil, and sexual intercourse.

A 14-year follow-up study of chest pain patients including stress hormones and mental stress at index event

Background Knowledge of long-term outcome in chest pain patients is limited. We reinvestigated patients who 14 years earlier had visited the emergency department due to chest pain, and were discharged without hospitalization. Extensive examinations were made at that time on 484 patients including full medical history, exercise test, a battery of stress questions and stress hormone sampling. Methods From a previously conducted chest pain study patients still alive after 14 years were approached. Hospitalization or deaths with a diagnosis of ischemic heart disease or cerebrovascular disease were used as end point. Results During the follow-up period 24 patients had died with a diagnosis of ischemic heart or cerebrovascular disease, and 50 patients had been given such a diagnosis at hospital discharge. Age (OR 1.12, CI 1.06–1.19), previous history of angina pectoris (OR 9.69, CI 2.06–71.61), pathological ECG at emergency department visit (OR 3.27, CI 1.23–8.67), hypertension (OR 5.03, CI 1.90–13.76), smoking (OR 3.04, CI 1.26–7.63) and lipid lowering medication (OR 14.9, CI 1.60–152.77) were all associated with future ischemic heart or cerebrovascular events. Noradrenalin levels were higher in the event group than in the non-event group, mean (SD) 2.44 (1.02) nmol/L versus 1.90 (0.75) nmol/L. When noradrenalin was included in the regression model high maximal exercise capacity was protective of an event (OR 0.986, CI 0.975–0.997). Conclusion In chest pain patients previous history of angina pectoris, hypertension, smoking, pathological ECG at primary examination, and age were the main risk factors associated with future cardiovascular or cerebrovascular events.

Von Willebrand factor, tissue plasminogen activator, and dehydroepiandrosterone sulphate predict cardiovascular death in a 10 year follow up of survivors of acute myocardial infarction

BackgroundHaemostasis plays a major part in the process initiating a myocardial infarction. The impact of haemostatic variables on long term prognosis is unknown.ObjectiveTo evaluate von Willebrand factor (vWF), tissue plasminogen...

Subjective symptoms and well-being differ in women and men after myocardial infarction.

The frequency of subjective cardiac and psychological complaints among men and women a year after a confirmed diagnosis of myocardial infarction (MI) were compared. Among 660 survivors, 595 patients completed mailed questionnaires at home one year after the MI. There were 421 men, mean age 67.1 +/- 10.7 years, and 174 women, mean age 72.1 +/- 10.6 years. Controlling for the significantly higher mean age among the women, the latter more often had a previous history of angina pectoris, 54.6% (P < or = 0.05) versus 42.9%, and heart failure, 24.7% versus 13.5% (P < or = 0.01). Despite these facts, the women were significantly less often referred to CCU, 82.2% versus 91.7% (P < or = 0.05). One year after the MI, controlling for differences in age and co-morbidity, women reported significantly higher frequencies of psychological and psychosomatic complaints, including sleep disturbances. These differences may have clinical implications for diagnosis and treatment of women with coronary heart disease.

Prognostic significance of angina pectoris recurring soon after myocardial infarction.

The prognostic significance of an early occurrence, or recurrence, of angina pectoris after myocardial infarction was studied in 254 patients (221 male, 33 female; mean age 58 +/- 11 years). During the in-hospital rehabilitation program, 41 patients (16%) had anginal pain. The mean follow-up was 21 months (range 12-33 months). Among the 254 patients, 21 died, five had recurrent myocardial infarction, 13 had unstable angina, and 22 underwent aortocoronary bypass surgery. An early recurrence of angina pectoris was predictive of combined (medical + surgical) events (21 patients, P less than 0.05), medical events (11 patients, P less than 0.05) and surgical events (10 patients, P less than 0.001), but failed to predict individual death (six patients), recurrent myocardial infarction (two patients) or unstable angina (three patients). Of the events that occurred in the 254 patients, 34% were predicted by the early recurrence of angina pectoris. Early post-infarction angina was observed more frequently in older patients and patients with previous history of angina pectoris. This represents an important prognostic factor after myocardial infarction, which defines a high-risk group of patients requiring further investigation and appropriate therapeutic approaches.