Symptoms Of Acute Coronary Syndrome Research Articles

A cross-sectional study of Hispanic and Latina/o/x/e individuals’ acute coronary syndrome symptom knowledge, attitudes, and beliefs

BackgroundLittle attention has been placed on language proficiency as a potential variable affecting ACS symptom knowledge, attitudes, and beliefs. ObjectivesTo compare the ACS symptom knowledge, attitudes, and beliefs of Hispanic and Latina/o/x/e individuals proficient in English and in those only proficient in Spanish. Secondary aims were to determine if there were differences in ACS symptom knowledge, attitudes, or beliefs based on participants’ previous exposure to ACS symptom information and to evaluate instrument characteristics of the new Spanish version of the ACS Response Index. MethodsThis cross-sectional, comparative study included participants (N = 99) from a community-based clinic in Illinois. Knowledge, attitudes, and beliefs related to ACS symptoms were measured using the ACS Response Index. ResultsThe average participant was 39.8 (SD 15.6) years of age, female (n = 56, 56.6 %), and had a high school education or less (n = 61, 61.6 %). Participants correctly classified a mean 57.5 % (SD 12.8) of symptoms and had mean attitude and belief scores of 12.1 (SD 3.3) and 17.5 (SD 2.9), respectively. There were no significant differences in knowledge, attitudes, and beliefs based on language proficiency. However, there were some statistically significant differences for knowledge and attitude scores based on exposure to ACS symptom information. The ACS Response Index (Spanish Version) also demonstrated favorable internal consistency. ConclusionsOverall knowledge, attitude, and belief scores were modest in this sample. Higher knowledge and attitude scores were observed for some types of ACS information exposure, supporting the importance of future educational efforts in this population.

Diagnostic performance of a point of care high-sensitivity cardiac troponin I assay and single measurement evaluation to rule out and rule in acute coronary syndrome.

About 10 million individuals in USA presented annually in the emergency department (ED) with chest pain or with signs and symptoms of acute coronary syndrome (ACS). The advent of point of care (POC) devices, able to measure high sensitivity troponin, are a very interesting tool in the ED setting for its rapid turnaround time (<10 min). The present study evaluates the diagnostic performance of the Atellica VTLi (Siemens) in real life setting using the clinical data derived from integrated diagnoses of emergency room staff and cardiologist and in comparison with standard laboratory hs-cTnT assay (Cobas 8000, Elecsys, Roche). 966 patients admitted to the emergency department of "G. Mazzini Hospital" in Teramo, Italy, from July 27, 2022, through June 09, 2023, were enrolled. The diagnostic performance of POC hs-cTnI was evaluated. An appropriate POC hs-cTnI threshold values <4 ng/L supplied a sensitivity and an NPV of 100 % (95 % CI: 99.5-100) in order to achieve rapid rule out for MI through asingle measurement at patient presentation in the ED. Furthermore, a derivation POC hs-cTnI concentration >54 ng/L provided a specificity of 97.2 % (95 % CI: 95.9-98.1) and a PPV of 43.5 % (95 % CI: 40.3-46.7) for ruling in MI. This platform showed comparable diagnostic performance for myocardial infarction to the central laboratory. Our data suggest the possible use of the Atellica VTLi hs-cTnI POC assay either in emergency department of urban medical centre, either in rural hospital for triage and patient management.

ACUTE MYOCARDIAL INFARCTION IN A PUERPERA: A CASE REPORT

We report a lethal case of acute myocardial infarction in a puerpera. Cardiovascular diseases rank as the leading causes of mortality during pregnancy and the postpartum period, with myocardial infarction (MI) being a rare yet frequently fatal occurrence. Research indicates that MI typically manifests between 6 to 12 weeks postpartum, though instances may also occur at later stages. The reported case is interesting in terms of the mismatch between the timing of clinical symptoms of acute coronary syndrome (less than 24 hours) in the puerpera and alterations in myocardial infarction (2-3 days), which was diagnosed morphologically. Therefore, we searched for possible causes that led to the clinical and morphological changes described above. At first glance, the main cause of myocardial infarction development is coronary artery dissection with the formation of hematoma in the wall of the blood vessel, which narrows its lumen and leads to necrosis of the heart muscle. A brief analysis of the case has established that ischemic damage to the myocardium preceded the development of spontaneous coronary artery dissection and could be caused by one of the factors or a combination of them: coronary artery spasm caused by ergometrine and anemia due to uterine atony-related postpartum hemorrhage. The formation of intramural hematoma of the vascular wall, which narrowed the lumen of the coronary artery, could be the result of the prescription of antithrombotic therapy, which complicated the health status of the woman and led to death. When providing medical care to puerperas with postpartum hemorrhage, it is necessary to take into account the risk for cardiovascular complications that could develop due to anemia or administration of ergometrine.

Gender disparities in the mediating role of symptom knowledge level in reducing acute coronary syndrome (ACS) decision delay: Findings from a community-based study in China

BackgroundImplementing training programs to educate patients on the prodromal symptoms of acute coronary syndrome (ACS) may assist patients in accurately recognizing these symptoms, and ultimately decrease their time delay in seeking emergency medical services (EMS). However, the effectiveness of this approach remains uncertain, particularly among the Chinese population.MethodsA cross-sectional study was conducted within 22 communities in Beijing, China between 2015 and 2018, with a total of 1099 participants recruited. The study utilized a standardized questionnaire to evaluate the presence of intentional decision delay in turning to EMS under a hypothetical chest pain, the participants’ knowledge of ACS prodromal symptoms, and whether they had ever received any training programs aimed at increasing their symptom knowledge. Mediation analysis was performed with regression models and bootstrapping methods, and gender difference was further analyzed through moderated mediation analysis.ResultsA total of 1099 participants (58.2% female, median [IQR] age 34 [20]) were included in the study. The results of the mediation analysis indicated that training programs were associated with a decrease risk in decision delay, with increased knowledge playing a mediating role (mediation effect/total effect = 36.59%, P < 0.0001). Gender modified this mediation effect, with it being observed only in the male group. Specifically, training programs were not found to significantly decrease decision delay among females (P > 0.05), even though they did improve women’s knowledge of ACS prodromal symptoms (β = 0.57, P = 0.012).ConclusionThe results suggested a relationship between prior training programs and reduced decision delay, with increased knowledge of prodromal symptoms of ACS serving as a mediator. However, the effect was only observed in male participants and not in female participants. This highlights the notion that mere transfer of knowledge regarding ACS prodromal symptoms may not be sufficient to mitigate decision delay in the female population. Further research is needed to corroborate these results and to gain deeper insights into the gender-specific barriers encountered in this study.

Difficulties in myocarditis diagnosis: a case report

Myocarditis is often difficult to diagnose. The diagnostic difficulties include nonspecific symptoms or a “vague” clinical picture, absence of pathognomonic signs during physical examination, and endomyocardial biopsy, which is the “gold standard” of diagnosis of myocarditis, being an invasive procedure that is performed under strict indications in certain patients. Nevertheless, as radiology is rapidly developing, clinicians are now able to noninvasively diagnose symptoms of inflammatory myocardial damage, including edema and myocardial fibrosis, using cardiac magnetic resonance imaging. This article presents the clinical case of a young patient with symptoms of acute coronary syndrome, who showed no evidence of coronary artery disease. Myocarditis was suspected because of increased activity of cardiospecific enzymes and high levels of inflammatory markers, pronounced electrocardiography changes with positive dynamics, and recent infection. Magnetic resonance imaging was used to confirm myocarditis diagnosis. Thus, this case study demonstrates the role of imaging techniques in the differential diagnosis of ischemic and inflammatory heart diseases.

Emergency Nurses’ Recognition of and Perception of Sex Differences in Acute Coronary Syndrome Symptoms

IntroductionEmergency nurses must quickly identify patients with potential acute coronary syndrome. However, no recent nationwide research has explored nurses’ knowledge of acute coronary syndrome symptoms. The purpose of this study was to explore emergency nurses’ recognition of acute coronary syndrome symptoms, including whether nurses attribute different symptoms to women and men. MethodsWe used a cross-sectional, descriptive design using an online survey. Emergency nurses from across the United States were recruited using postcards and a posting on the Emergency Nurses Association website. Demographic data and participants’ recognition of acute coronary syndrome symptoms, using the Acute Coronary Syndrome Symptom Checklist, were collected. Descriptive statistics and ordinal regression were used to analyze the data. ResultsThe final sample included 448 emergency nurses with a median 7.0 years of emergency nursing experience. Participants were overwhelmingly able to recognize common acute coronary syndrome symptoms, although some symptoms were more often associated with women or with men. Most participants believed that women and men’s symptoms were either “slightly different” (41.1%) or “fairly different” (42.6%). Nurses who completed training for the triage role were significantly less likely to believe that men and women have substantially different symptoms (odds ratio 0.47; 95% CI 0.25-0.87). DiscussionEmergency nurses were able to recognize common acute coronary syndrome symptoms, but some reported believing that the symptom experience of men and women is more divergent than what is reported in the literature.

Severe mental illness and symptoms of acute coronary syndrome in emergency calls

Abstract Background It can be lifesaving to act fast and correct when acute life-threatening diseases occur. This is, however, challenging in some patients with severe mental illness as they sometimes experience symptoms differently than patients without severe mental illness. This changed perception can affect the patients’ chances of receiving adequate help, as these patients are already stigmatized even by healthcare personnel. Purpose We aimed to determine whether patients with severe mental illness reported different symptoms of acute coronary syndrome (ACS) in emergency calls than patients without severe mental illness. Methods In this registry-based study, we analyzed symptoms of ACS in emergency calls made from 2014 to 2018 in the Capital Emergency Medical Services, including the Emergency Number (1-1-2) and the Out-of-hours Service (medical helpline). The study population comprised patients with severe mental illness (defined by schizophrenia, bipolar affective disorder, and depression) and a control group of patients without severe mental illness. Additionally, we investigated whether psychotropics (defined by antipsychotics, mood stabilizers, and antidepressants) were associated with altered symptom presentation of ACS. Furthermore, we determined the time from the emergency call to hospitalization. Analyses were performed by logistic regression adjusted for sex and age and t-tests. Results In total, 11,113 emergency calls were included; 917 were from patients with severe mental illness (45.4% were female, average age was 64.6 years), and 10,196 were from patients without severe mental illness (35.3% were female, average age was 67.7 years). Severe mental illness was associated with less frequent chest pain in ACS (odds ratio 0.80, 95%CI: 0.70-0.92, p=0.002). Furthermore, treatment with psychotropics was associated with less frequent chest pain in ACS (odds ratio 0.73, 95%CI: 0.64-0.82, p&amp;lt;0.001). The mean time difference from the emergency call to hospitalization was 17 minutes longer for patients with severe mental illness (1 hour 21 minutes vs. 1 hour 4 minutes, p=0.002) Conclusion Patients with severe mental illness presented less frequent chest pain in ACS in emergency calls than patients without severe mental illness and had increased time to hospitalization. This calls for increased awareness of symptom presentation in patients with severe mental illness to improve the identification and management of ACS.

Contribution of the left atrial speckle tracking in the evaluation of left ventricule filling pressure in acute coronary syndromes

Abstract Introduction A non invasive estimation of diastolic function with echocardiography according to consensual methods, ie American society of Echocardiography (ASE) / European association of cardiovascular imaging (EACVI) algorithm 2018, is considered an integral essential part of the clinical evaluation of patients presenting with symptoms of acute coronary syndrome (ACS). Left atrial (LA) longitudinal strain in the frame of speckle tracking echocardiography (STE) was reported recently to have additive diagnostic value to assess left ventricle (LV) filling pressures (LVFP) in a large spectrum of cardiovascular diseases. Our study aim is to assess the accuracy of LA strain in evaluating LVFP in patients with ACS, as a single parameter. Methods Our study was monocentric in our cardiology department led prospectively between April 20, 2022, and June 30, 2022. We included all patients admitted to our department for evolving ST elevation (STEMI) or non-ST elevation (NSTEMI) myocardial infarction (&amp;lt;48 hours from onset of symptoms). Echocardiographic measurements were performed according to ASE/EACVI in less than 24 hours. They were divided into two groups according to the elevation of LVFP group 1 with non-elevated LVFP vs group with elevated LVF. LA-GS was assessed using images obtained in apical 4- and 2-chamber views , with attention to optimal visualization of the LA. The endocardial border of the LA was traced manually. Left atrial reservoir strain (LARS) was calculated from LV-end diastole, and pump strain (LAPS) after the onset of the p-wave in the electrocardiogram. Results Fifty patients were included in our study. The mean age was 59 ± 12 years. 72%(36) of our population was men. 34%(17) of the population had elevated LVFP (Group2) with a male predominance of 82% (14). They were active smokers in 64% (11), 52%(9) had hypertension, 70% (12) had diabetes mellitus, 47%(8) had dyslipidemia and 35% (6) were hospitalized for NSTEMI. The mean LARS and LAPS were 26.9%, and 15.2% in group 1 vs 15.1%, and 7.1% respectively in group 2 with a difference statically significative p = 0.001, and p = 0.002 respectively. The area under the curve was 0.910 (LARS) and 0.850 (LAPS). The best cut-off for the LAPS was 11.5% with 100% of sensibility and 63% of specificity, for the LARS the best cut-off was 18% with 95% of sensibility and 66% of specificity. Conclusion LA-GS includes a reproducible and simple method for LVFP assessment in ACS. it provides an additional variable that can contribute when one of the other parameters is missing.

Predictores cognitivos y toma de decisiones en la experiencia de los síntomas del síndrome coronario

ObjectiveTo determine the predictive value of Cognitive Assessment, Symptom Severity, Personal Control and Self-Efficacy on decision making in the experience of Acute Coronary Syndrome symptoms. MethodQuantitative study of cross-sectional analytical design, a probabilistic sampling was carried out for 256 participants diagnosed with coronary syndrome in three health institutions. The effects between the independent variables Cognitive Assessment, Symptom Severity, Personal Control, Self-Efficacy and the dependent Decision-Making were analyzed. Using inferential statistics, a Generalized Linear Regression Model was carried out, which allowed establishing the causal relationships between the variables. ResultsTwo predictive models were obtained between decision making and cognitive evaluation, in which personal control, severity of symptoms, sex and context were significant. Self-efficacy was not reported as a predictor variable. The values of the independent variables showed a behavior directly proportional to the Decision Making score. ConclusionA verification of the conceptual model for the management of symptoms was carried out.

THE RELATIONSHIP BETWEEN RISK FACTORS OF ACUTE CORONARY SYNDROME AND HEALTHY LIFESTYLE BEHAVIORS IN PATIENTS WHO APPLIED TO THE EMERGENCY DEPARTMENT WITH CHEST PAIN

Objective: Chest pain is one of the potential symptoms of acute coronary syndrome and is the second most common emergency worldwide. Acute coronary syndrome tends to be seen in patients aged

Gender and Age-Based Differences in Risk Factors and Symptoms of Acute Coronary Syndrome in a Sample of Iranian Patients

Background: Acute coronary syndrome (ACS) is one of the most serious diseases with high mortality. Concerning the influence of age and gender on ACS properties, this study aimed to determine gender and age-based differences in risk factors and symptoms of the ACS in a sample of Iranian patients. Methods: This cross-sectional study was conducted on 450 patients with ACS in Kerman from 10 September, 2018 to 25 February, 2019. The data were collected through face-to-face interviews in the coronary care unit (CCU) after ACS diagnosis. A trained interviewer collected the data using a demographic and clinical information checklist. Statistical analyses were performed using chi-square, Fisher exact test, and Mann‐Whitney U test and through SPSS software (version 23). Results: In this study, more than half of the patients with ACS were males (n=240, 53.4%). In one-third of the patients, ACS symptoms were presented in the age range of 60-69 years (n=145, 32.2%). In the female patients compared to the male patients, there were more cases of underweight [58 (27.6%) versus 45 (18.8%), P value: 0.02], positive family history of coronary heart disease (CHD) [102 (48.6%) versus 92 (38.3%), P value: 0.02], and hypertension [119 (56.7%) versus 113 (47.1%), P value: 0.04]. In contrast, there were no differences in common symptoms and pain severity in patients in various age and sex groups. Conclusion: Attention to the differences in the profile of risk factors and symptoms of ACS in males and females of different ages, would be helpful in choosing the best clinical approach.

Influence of Patient and Clinician Gender on Emergency Department HEART Scores: A Secondary Analysis of a Prospective Observational Trial

Clinical decision aids can decrease health care disparities. However, many clinical decision aids contain subjective variables that may introduce clinician bias. The HEART score is a clinical decision aid that estimates emergency department (ED) patients' cardiac risk. We sought to explore patient and clinician gender's influence on HEART scores. In this secondary analysis of a prospective observational trial, we examined a convenience sample of adult ED patients at one institution presenting with acute coronary syndrome symptoms. We compared ED clinician-generated HEART scores with researcher-generated HEART scores blinded to patient gender. The primary outcome was agreement between clinician and researcher HEART scores by patient gender overall and stratified by clinician gender. Analyses used difference-in-difference (DiD) for continuous score and prevalence-adjusted, bias-adjusted Kappa (PABAK) for binary (low versus moderate/high risk) score comparison. All 336 clinician-patient pairs from the original study were included. In total, 47% (158/336) of patients were women, and 52% (174/336) were treated by a woman clinician. The DiD between clinician and researcher HEART scores among men versus women patients was 0.24 (95% CI-0.01 to 0.48). Compared with researchers, men clinicians assigned a higher score to men versus women patients (DiD 0.51 [95% CI 0.16 to 0.87]), whereas women clinicians did not (DiD 0.00 [95% CI-0.33 to 0.33]). Agreement was the highest among women clinicians (PABAK 0.72; 95% CI 0.61 to 0.81) and lowest among men clinicians assessing men patients (PABAK 0.47; 95% CI 0.29 to 0.66). Patient and clinician gender may influence HEART scores. Researchers should strive to understand these influences in developing and implementing this and other clinical decision aids.

Atypical Symptoms of Acute Coronary Syndrome and Their Predictors

Introduction: The most important diagnostic indicator of Acute Coronary Syndrome (ACS) is typical clinical symptoms, like chest pain, but many patients may experience nonspecific (atypical) symptoms. Understanding these symptoms and their associated factors results in early diagnosis and more appropriate treatments. Objective: We aimed to determine atypical clinical symptoms and their predictors in patients with Acute Coronary Syndrome. Materials and Methods: This cross-sectional study was conducted on 1167 patients with ACS hospitalized at a specialized hospital in Rasht City, Iran, between December 2019 and October 2020. The research samples were selected by a consecutive sampling method. Data were collected through a researcher-made questionnaire by interview, in which sociodemographic characteristics, risk factors, disease-related factors, and symptoms of patients with ACS were collected. Data analysis was done by descriptive statistics and multiple logistic regression by the backward LR (likelihood ratio) method. The significance level was set as P&lt;0.05. Results: In this study, 56.3% of the patients were male. The Mean±SD age of the patients was 60.9±11.1 years. About 28.1% of the patients experienced atypical clinical symptoms. The most common atypical symptoms were shortness of breath (29.4%), back pain (18.3%), and left shoulder pain (12.7%). The predictors of atypical symptoms were age (OR=0.98, 95% CI; 0.975 - 0.999, P=0.047), alcohol use (OR=1.86, 95% CI; 1.047 - 3.303, P=0.034), brain diseases (OR=2.36, 95% CI; 1.463 - 3.811, P=0.001), blood diseases (OR=1.45, 95% CI; 1.059 - 2.002, P=0.021), and gastroesophageal reflux (OR=1.31, 95% CI; 1.006 - 1.719, P=0.045) Conclusion: Since more than a quarter of ACS patients have unusual symptoms, detecting these symptoms and related factors can help in early diagnosis and conduct more appropriate medical treatment.

Predictors of acute coronary syndrome symptom knowledge, attitudes, and beliefs in adults without self-reported heart disease

BackgroundThe time of symptom onset to the time an individual decides to seek care is the most significant contributor to total treatment delay. ObjectivesTo explore predictors of ACS symptom knowledge, attitudes, and beliefs in adults without diagnosed heart disease. MethodsWe used a cross-sectional, descriptive, and correlational design, employing an online survey including the ACS Response Index and the avoidance subscale of the Coping Strategy Indicator. We leveraged social media platforms and a university email list-serv to enroll participants. Stepwise hierarchical linear regressions were used. ResultsWe analyzed responses from 981 participants, with a mean age of 35.2 years (SD 16.5) and 75% female. The regression analyses yielded models that explained 14%, 23%, and 25% of the variance for knowledge, beliefs, and attitudes, respectively. Ethnicity, race, exposure to ACS symptom information (in the media or by teaching), and perceived health were the predictors of ACS symptom knowledge, attitudes, and beliefs with the largest effect, though others were statistically significant. ConclusionsThe findings underscore the importance of community education to raise awareness of ACS symptoms while considering social determinants of health. Future research and clinician interventions for ACS symptom knowledge, attitudes and beliefs should be expanded with a focus on ethnicity and gender.

Perivascular fat attenuation index measured by coronary computed tomography angiography as a tool for assessment of ischaemia-causing lesions: a case report

BackgroundIt can be difficult to diagnose coronary artery disease in patients with acute coronary syndrome if coronary angiography does not identify stenosis. Coronary inflammation, which can contribute to the pathogenesis of coronary artery disease and acute coronary syndrome, can be quantified using the perivascular fat attenuation index. Furthermore, the perivascular fat attenuation index is a marker for all-cause mortality, cardiac-related mortality and impaired global coronary flow reserve.Case presentationHere we report a case of a patient presenting with symptoms of acute coronary syndrome. The patient had hypokinesis of the lateral-posterior wall of the left ventricle, decreased myocardial perfusion in the posterior wall myocardium and elevated myocardial troponin-T and creatine phosphokinase levels. However, coronary computed tomography angiography did not identify arterial stenosis. The patient did have an increased perivascular fat attenuation index, indicating coronary inflammation. Moreover, the fat attenuation index was higher around the left circumflex artery than around the right coronary artery or left anterior descending artery. Intravascular ultrasonography identified an intramural haematoma, leading to a diagnosis of type 3 spontaneous coronary artery dissection in the left circumflex artery.ConclusionsPerivascular fat attenuation index may be a useful tool to help identify and localise disease-causing lesions, and to direct further testing to confirm a diagnosis of spontaneous coronary artery dissection in acute coronary syndrome patients without significant arterial stenosis.

Preoperative Workup of Operative Hip Fracture Patients: A Survey

Background: There may be disagreement among stakeholders on the need for preoperative cardiac screening for elderly hip fracture patients. Purpose: We sought to assess preoperative workup perceptions among physicians for hip fracture patients across specialties, specifically considering a patient’s cardiovascular risk. Methods: A case-based survey was distributed to 50 physicians in each of the 4 departments involved in preoperative patient care: orthopedic surgery (OS), anesthesiology (A), cardiology (C), and hospital medicine (HM). The survey asked about which clinical presentations required a cardiology consult, as well as about further preoperative imaging and laboratory work. Single score intraclass correlation coefficient (ICC) was used to compare agreement. Results: Of the 200 surveys sent out, 33 responses (16.5% response rate) were received. Between all specialties, there was 72% agreement about preoperative cardiology consult need (intraclass correlation coefficient [ICC] = 0.063 or poor) and 71% agreement about preoperative transthoracic echocardiogram (TTE) need (ICC = 0.188 or poor). Within each specialty (A, C, HM, OS) ICCs measuring agreement for the need for cardiology consult were 0.812 (good), 0.561 (moderate), 0.457 (poor), and 0.414 (poor), respectively, and for the need for preoperative TTE were 0.852 (good), 0.441 (poor), 0.848 (good), and 0.188 (poor), respectively. Common preoperative testing requested included complete blood count, basic metabolic panel in all cases, and electrocardiogram with troponins if perioperative acute coronary syndrome symptoms were present. Conclusion: This survey suggests that there may be varying levels of agreement within specialties and poor agreement between specialties on the need for cardiology consultation and preoperative imaging for hip fracture patients. This suggests the need for established, reliable preoperative workup protocols with input from different specialties to streamline preoperative care for patients before hip fracture surgery.

The Effect of the Family-Centered Self-Care Program on the Health Literacy Level and Self-Efficacy of Patients with Acute Coronary Syndrome During Discharge from Hospital.

One of the factors effective in controlling acute coronary syndrome (ACS) symptoms, such as heart failure, is sufficient knowledge of the disease, factors effective on its occurrence, and its prevention. Moreover, the improvement of self-efficacy, which is a predictor of important life factors in these patients, such as treatment process and quality of life (QOL), must be considered as one of the main goals of nursing care for these patients. The aim of this study was to determine the effect of the family-centered self-care program on the health literacy level and self-efficacy of patients with ACS during hospital discharge. The present study was a quasi-experimental study performed with a pretest-posttest design. The statistical population of the study consisted of all patients with ACS hospitalized at Shahid Chamran Hospital in Isfahan in 2020. Through the convenience sampling method, 50 patients were selected and randomly divided into intervention and control groups. For the intervention group, 6 sessions of 45-60 minutes of family-centered self-care intervention were held. The subjects completed the Health Literacy for Iranian Adults (HELIA) questionnaire before and after the intervention. Data were analyzed using Chi-square test, independent t-test, and paired t-test in the SPSS statistical software. The mean score of health literacy did not significantly differ between the intervention and control groups before the intervention (p > 0.050). However, after the intervention, this rate was equal to 82.16 (7.94) and 60.85 (15.71) in the intervention and control groups, respectively, which was significantly higher in the intervention group compared to the control group (p < 0.001). Furthermore, there was no significant difference between the two groups in terms of the mean self-efficacy score before the intervention (p > 0.05). However, after the intervention, this score was significantly higher in the intervention group 34.71 (10.11) compared to the control group 35.22 (13.30). Family-centered self-care program after discharge, as a simple, applicable, and efficient method can improve the health literacy level and self-efficacy of patients with ACS.

Recurrent Takotsubo syndrome: case report and literature review

Abstract Introduction: Takotsubo syndrome is a cardiomyopathy that can lead to severe myocardial involvement. It is characterized by the presence of signs and symptoms suggestive of ventricular dysfunction associated with an adrenergic discharge during a stressful event. This case report presents a literature review, as well as a comparison with other similar cases. Case presentation. A 56-year-old female with a previous episode of Takotsubo was admitted to the emergency department due to symptoms of acute coronary syndrome and a history of Takotsubo syndrome. Her electrocardiogram showed T-wave inversion in leads V1-V4 and a raise in troponins. Percutaneous coronary angiography revealed no coronary lesions, and an echocardiogram revealed segmental alterations compatible with Takotsubo syndrome, requiring medical therapy with beta-blockers and angiotensin-converting enzyme (ACE) inhibitors, with subsequent improvement in ventricular function. Conclusions. Recurrence in Takotsubo cardiomyopathy is a rare complication that should be suspected. The risk factors associated with recurrence are not known. Although therapy with ACE inhibitors and beta-blockers seems to have an impact on the recovery of ventricular function in patients with this condition, further studies are necessary to establish the best pharmacological treatment.

Abstract 11529: Sociodemographic and Clinical Variables Predict Acute Coronary Syndrome Symptom Knowledge, Attitudes, abd Beliefs in Adults Without Diagnosed Heart Disease

Introduction: Little research has focused on the acute coronary syndrome (ACS) symptom knowledge, attitudes, and beliefs of younger individuals and those without diagnosed heart disease, even though most ACS events are first-time events, and ACS rates are increasing in the young. Purpose: To identify predictors of ACS symptom knowledge, attitudes, and beliefs in younger people without diagnosed heart disease. Methods: Participants were recruited from social media platforms in fall 2020 and completed an online survey including the ACS Response Index instrument. Multiple linear regressions were run to model ACS symptom knowledge, attitudes, and beliefs as a function of selected demographic and clinical variables that have documented or theoretical importance. Results: A typical participant from the sample (n=765) was 36.4 years old (SD = 16.7), a woman (n=573; 74.9%), white (n=686; 89.7%), and non-Hispanic/Latino (n=706; 92.3%). Hispanic/Latino participants had lower ACS symptom knowledge and attitude scores than non-Hispanic/Latino participants, (β = -.26, t (757) = -7.79, p = .000; β = -1.32, t (755) = -2.86, p = .000, respectively), and white participants had substantially higher ACS symptom attitude scores than non-white, (β = 1.21, t (755) = 3.35, p = .001). Men had lower knowledge scores than women, (β = -6.48, t (757) = -4.41, p = .000). Additionally, participants who reported being taught by a healthcare professional about signs and symptoms of ACS had substantially higher symptom knowledge and attitude scores compared to those who had not, (β = 3.70, t (757) = 3.01, p = .003; β = 2.15, t (755) = 11.68, p = .000, respectively) and so did those who reported exposure to information about these symptoms in the media compared to those who did not, (β = 6.68, t (757) = 4.37, p = .003; β = 1.07, t (755) = 4.58, p = .000, respectively). Other variables, such as use of avoidance coping, self-perceived risk of heart disease, nicotine use, and self-perceived health, also predicted knowledge, attitude, and/or belief scores. Conclusions: Gender, race, and previous exposure to information about ACS symptoms were particularly important predictors of ACS symptom knowledge and attitudes, though others were significant. Additional research is needed in more diverse samples.

Abstract 13629: Unique Age- and Sex-Specific Patterns Identified for Prodromal Symptoms of Sudden Cardiac Arrest

Introduction: The majority of individuals who suffer sudden cardiac arrest (SCA) display prodromal symptoms in the preceding hours, days and weeks. These could potentially improve risk assessment for SCA, making it important to explore the influence of age and sex on symptom manifestation. Hypothesis: Prodromal symptoms of SCA are different based on age and sex. Methods: We included cases of witnessed SCA (ages 35-85) attended by emergency medical services following 911 calls made in Ventura County, CA (2015-2021). SCA was defined as a sudden, unexpected pulseless condition of likely cardiac origin; non-cardiac etiology were excluded. All cases were required to have at least one inclusion symptom recorded in the EMS narrative at the time of the 911 call. These were acute coronary syndrome (ACS) or SCA symptoms reported in the published literature. We constructed mutually exclusive symptom groups in hierarchical order: chest pain, dyspnea, syncope/palpitations, and other. We compared symptoms in middle age (35-64y) and older (65-85y) cases using chi-square tests. Results: Of 404 SCA cases that met analysis criteria, 122 (30%) were female. Women comprised 22% of the middle-age group and 37% of the older group. In the middle-age group, chest pain was the most common symptom among men (48%) but was half as common in women (24%, p&lt;0.01, Figure). Among middle-aged women, dyspnea was the most common symptom (39%) and significantly higher compared to men (22%, p &lt;0.05). Chest pain prevalence was lower in both sexes in the older group (31% in men vs 20% in women). We observed no significant differences in dyspnea by sex in the older group, nor differences in syncope/palpitations or other symptoms in either group by sex. Conclusions: We observed unique pre-SCA prodromal symptom patterns after stratifying by age and sex, most notable in middle age. These findings suggest the importance of considering age and sex while developing SCA prediction algorithms that include prodromal symptoms.