Symptoms Of Acute Myocardial Infarction Research Articles

Prehospitalno detektovan akutni infarkt miokarda sa ST elevacijom kod COVID 19 pozitivnog pacijenta

Introduction/Objective Even during the coronary virus disease (COVID-19) pandemic, patients can develop symptoms of acute myocardial infarction with ST elevation (STEMI). We are presenting the case of a COVID-19 positive patient with STEMI diagnosed in a prehospital setting, with differential diagnosis questions during hospitalization and implementation of high personal protection standards by medical staff during his treatment. Case report on 4th April 2020, at 12.26 A.M. a medical emergency team was dispatched to transport a 51-year-old male patient from the Vozdovac Community Health Center infirmary to a catheterization lab for a possible STEMI. Upon arrival at 12.39 P.M., the patient complained of retrosternal chest pain that he described as an 8/10 in severity. The pain commenced two hours earlier at rest. He did not have a respiratory infection and the epidemiological survey for COVID-19 was negative. On examination, he was conscious, oriented, communicative, subfebrile (37.1°C), normotensive (130/70mmHg), eupneic (18 breaths/min), with normal auscultatory breath sounds and a blood oxygen saturation level of 98%. Heart sounds are of regular rate (62 bpm) and rhythm, with no murmurs and no signs of decompensation. The electrocardiography (ECG) recorded at the Health Centre showed an ST elevation in lateral leads, which was confirmed on the ECG recorded by the emergency medical system (EMS). An IV catheter was placed and dual antiplatelet therapy was administered. At the Institute for Cardiovascular Diseases Dedinje, a SARS-COV-2 IgG/IgM rapid test showed that the patient was positive for Coronavirus. Arrangements were made and at 1 P.M. the hemodynamically stable patient was transported directly to the COVID-19 "Dr Dragiša Mišović" hospital catheterization lab. Along with STEMI, the differential diagnosis included myocardial infarction with nonobstructive coronary arteries (MINOCA), pulmonary embolism and myopericarditis, which were excluded after performing coronary angiography, echocardiography and computed tomography pulmonary artery angiography. While treating the patient, the medical staff on all levels used the recommended personal protective equipment. During hospitalization, the patient was hemodynamically stable with no rhythm abnormalities, eupneic, with blood oxygen saturation level ranging from 98-100% on room oxygen. The control nasopharyngeal swab came back SARS Cov2 negative on 5th May 2020. COVID-19 specific therapy was administered. The patient was discharged from the hospital with prescribed cardiac medication. He was ordered to self-isolate at home for 14 days, at which time another control swab would be taken. Conclusion Sometimes, a STEMI diagnosed in the prehospital setting does not represent the final diagnosis and it is necessary to take into consideration other differential diagnostic possibilities. A high level of safety strategy for all medical personnel is recommended on all levels when treating patients.

High-sensitivity-cardiac troponin for accelerated diagnosis of acute myocardial infarction: A systematic review and meta-analysis

ObjectivesCardiovascular disease is the leading cause of mortality and morbidity. Serial troponin tests have been endorsed as essential diagnostic steps to rule out/−in acute myocardial infarction (AMI), and hs-cTn assays have shown promise in enhancing the accuracy and efficiency of AMI diagnosis in the emergency department (ED). MethodsA systematic review and meta-analysis of diagnostic test accuracy studies were conducted to compare the diagnostic performance of various accelerated diagnostic algorithms of hs-cTn assays for patients with symptoms of AMI. Random-effects bivariate meta-analysis was conducted to estimate the summary sensitivity, specificity, likelihood ratios, and area under receiver operating characteristic curve. ResultsIn the systematic review consisting of 56 studies and 67,945 patients, both hs-cTnT and hs-cTnI-based 0-, 1-, 2- and 0–1 h algorithms showed a pooled sensitivity >90%. The hs-cTnI-based algorithm showed a pooled specificity >80%. The hs-cTnT-based algorithms had a specificity of 68% for the 0-h algorithm and of around 80% for the 1-, 2-, and 0–1 h algorithms. The heterogeneities of all diagnostic algorithms were mild (I2 < 50%). ConclusionBoth hs-cTnI- and hs-cTnT-based accelerated diagnostic algorithms have high sensitivities but moderate specificities for early diagnosis of AMI. Overall, hs-cTnI-based algorithms have slightly higher specificities in early diagnosis of AMI. For patients presenting ED with typical symptoms, the use of hs-cTnT or hs-cTnI assays at the 99th percentile may help identify patients with low risk for AMI and promote early discharge from the ED.

The effects of Citrus aurantium aroma on anxiety and fatigue in patients with acute myocardial infarction: A two-center, randomized, controlled trial

ObjectivesAnxiety and fatigue affect the clinical course and quality of life in patients with Acute Myocardial Infarction (AMI). Complementary therapies are recommended for managing these symptoms. The present study was conducted to evaluate the effects of Citrus aurantium aroma on anxiety and fatigue in patients with AMI admitted to coronary care units. DesignIn this triple-blind, randomized, controlled, clinical trial, 80 patients with AMI were allocated to a Citrus aurantium group and a placebo group (n = 40 per group) through stratified randomized blocks. From their second day of hospitalization and for two consecutive days, the subjects in the experimental and control groups inhaled three drops of Citrus aurantium essential oil or the placebo using absorbable patches connected to the inside of oxygen masks for 20 min. Anxiety and fatigue were measured in the patients using the Spielberger State-Trait Anxiety Inventory (STAI) and the Multidimensional Fatigue Inventory (MFI-20) 30 min before and 15 and 30 min after the interventions. ResultsThere was a statistically significant difference between the Citrus aurantium and placebo groups concerning the mean changes in their anxiety and fatigue scores (P < 0.001Citrus aurantium essential oil reduced anxiety and fatigue on all the four measurement occasions after the intervention compared to before. ConclusionAromatherapy with Citrus aurantium can be used as part of holistic care for managing the symptoms of AMI by nurses.

Diarrhea as Atypical Symptom of Acute Myocardial Infarction

Diarrhea as Atypical Symptom of Acute Myocardial Infarction

5232Inhibition of platelet aggregation after subcutaneous administration of a single-dose of selatogrel, a novel P2Y12 antagonist, in acute myocardial infarction: a randomised open-label phase 2 study

Abstract Background Oral P2Y12 receptor antagonists exhibit a delayed onset of platelet inhibition in patients experiencing acute myocardial infarction (AMI). Selatogrel is a potent, reversible, and highly selective P2Y12 receptor antagonist with a rapid onset and offset of action when administered subcutaneously. Purpose To assess inhibition of platelet aggregation (IPA) after subcutaneous (s.c.) single-dose administration of selatogrel in patients with AMI receiving standard concomitant therapy. Methods Male and postmenopausal female adults (≤85 years) presenting with type 1 AMI (ST-elevation MI [STEMI] or non-STEMI [NSTEMI]) and onset of AMI symptoms &gt;30 min to &lt;6 h were randomised (1:1) to receive a single s.c. dose of either 8 mg or 16 mg selatogrel. Blood samples were collected at baseline and at 15, 30, and 60 min post-dose and evaluated for ADP-induced platelet aggregation (expressed as P2Y12 reaction units [PRU]) using VerifyNow. The primary endpoint was the response to treatment (defined by PRU &lt;100) at 30 min post-dose. Safety was assessed up to 48 h post-dose. Results Forty-seven patients (median age 69 y; 72% male; 62% STEMI; 94% Killip class 1) received 8 mg (N=24) or 16 mg (N=23) selatogrel. Study-treatment concomitant medications included acetylsalicylic acid (98%), P2Y12 inhibitors (96%), heparins (94%), statins (94%), nitrates (68%) and morphine (38%). Oral ticagrelor (92%) with corresponding loading doses was only administered after selatogrel. The proportion of patients meeting the primary endpoint (responders) 30 min post-dose was 91% (95% CI: 72, 99) and 95% (95% CI: 77, 100) with 8 and 16 mg, respectively (p&lt;0.001 for both doses). Response rates were independent from STEMI/NSTEMI diagnosis, age and sex. A response was observed as early as 15 min (8 mg: 75% of patients [95% CI: 53, 90]; 16 mg: 91% of patients [95% CI: 72, 99]), and sustained up to 60 min post-dose (8 mg: 75% of patients [95% CI: 53, 90]; 16 mg: 96% of patients [95% CI: 78, 100]). Platelet reactivity was decreased following selatogrel administration (Figure; interquartile range [box], min and max [whiskers], median and mean [horizontal line and symbol, respectively, within the box]). Overall, 43% of patients had ≥1 treatment-emergent adverse event (TEAE), which were mainly of mild/moderate intensity. Ventricular tachycardia ([VT] 8 mg: 5/24; 16 mg: 3/23) was the most frequent TEAE. Treatment-emergent serious AEs of VT were reported in two patients receiving 8 mg (one patient also experienced ventricular fibrillation) and one patient receiving 16 mg selatogrel. Post-procedural haemorrhage (mild) occurred in one patient: bleeding at radial access after percutaneous coronary intervention (∼1 h after selatogrel 8 mg). Conclusion Single-dose administration of s.c. selatogrel (8 mg and 16 mg) induced a rapid IPA response in patients with AMI at 30 min (as early as 15 min and maintained at 60 min post-dose) and was well-tolerated with no major bleeding events. Acknowledgement/Funding Fully funded by Idorsia Pharmaceuticals Ltd

Takotsubo Cardiomyopathy: Medical and Psychiatric Aspects. Role of Psychotropic Medications in the Treatment of Adults with "Broken Heart" Syndrome.

Takotsubo cardiomyopathy (TTC) is reversible stress-induced cardiomyopathy featuring symptoms of acute myocardial infarction without significant coronary artery abnormalities. TTC is frequently precipitated by stressful emotional events but it also has been reported as a result of substance withdrawal, non-cardiac events, and dangerous drug-to-drug interaction. The plasma levels of both epinephrine and norepinephrine were significantly elevated in TTC patients, suggesting that elevated catecholamine levels might be the main contributing factor. However, the mechanisms underlying susceptibility to development and recurrence are not completely understood.It has been suggested that even a therapeutic dose of antidepressant could be a cause of drug-induced tachycardia and TTC. Moreover, some cases have been reported in which the development of TTC was associated with the serotonin syndrome, neuroleptic malignant syndrome, and similar fatal consequences.The aim of this article is to explore the association between underlying psychiatric disorders and TTC and to determine the role of various psychotropic medications in the progression of stress-induced cardiomyopathy. This article also notes and discusses the current theories underlying the pathophysiology of TTC. This review suggests a serious side effect of antidepressants, and to avoid life-threatening cardiovascular events, such as TTC, for patients with affective and anxiety disorders, prior screening for cardiovascular conditions by ECG with close monitoring might be necessary.

Treatment-Seeking Delay Among Hispanic and Non-Hispanic Women with Acute Myocardial Infarction.

Purpose: Women and minorities with acute myocardial infarction (AMI) often fail to recognize prodromal symptoms leading to delays in care. The objective of this study was to conduct a mixed method assessment of the impact of ethnicity on symptom description, recognition, and treatment-seeking behavior in Hispanic and non-Hispanic women before hospitalization for AMI.Methods: We explored differences in symptomatology, treatment-seeking behavior, and delay patterns among a convenience sample of 43 women diagnosed with AMI (17 Hispanic women, 26 non-Hispanic women) in seven rural and urban Colorado hospitals. We performed in-depth interviews to establish patterns (typologies) of treatment-seeking behaviors. Chart abstraction provided delay times as a function of ethnicity.Results: Most (28/43) women reported prodromal symptoms in the weeks before their index AMI. Overall, fewer Hispanic women presented within 24 h of symptom onset (3/18, 17% vs. 15/18, 83%, p<0.01). A typology of treatment-seeking behavior emerged: women who (1) recognized symptoms and promptly sought care; (2) did not recognize symptoms, yet promptly sought care; (3) recognized symptoms and promptly sought care, but providers misconstrued symptoms as noncardiac; and (4) misinterpreted symptoms due to an underlying chronic disease.Conclusion: Women and primary care providers often underappreciate prodromal AMI symptoms. Hispanic women are more likely to misinterpret ischemic symptoms and delay care, suggesting a need for tailored patient and provider education.

Symptoms Predictive of Acute Myocardial Infarction in the Troponin Era: Analysis From the TRAPID-AMI Study.

The TRAPID-AMI (High Sensitivity Cardiac Troponin T assay for rapid Rule-out of Acute Myocardial Infarction) study evaluated a rapid "rule-out" acute myocardial infarction (AMI). We evaluated what symptoms were associated with AMI as part of a substudy of TRAPID-AMI. There were 1282 patients evaluated from 12 centers in Europe, the United States of America, and Australia from 2011 to 2013. Multiple symptom variables were prospectively obtained and evaluated for association with the final diagnosis of AMI. Multivariate logistic regression analysis was done, and odds ratios (OR) were calculated. There were 213/1282 (17%) AMIs. Four independent predictors for the diagnosis of AMI were identified: radiation to right arm or shoulder [OR = 3.0; confidence interval (CI): 1.8-5.0], chest pressure (OR = 2.5; CI: 1.3-4.6), worsened by physical activity (OR = 1.7; CI: 1.2-2.5), and radiation to left arm or shoulder (OR = 1.7; CI: 1.1-2.4). In the entire group, 131 (10%) had radiation to right arm or shoulder, 897 (70%) had chest pressure, 385 (30%) worsened with physical activity, and 448 (35%) had radiation to left arm or shoulder. Duration of symptoms was not predictive of AMI. There were no symptoms predictive of non-AMI. Relationship between AMI size and symptoms was also studied. For 213 AMI patients, cardiac troponins I values were divided into 4 quartiles. Symptoms including pulling chest pain, supramammillary right location, and right arm/shoulder radiation were significantly more likely to occur in patients with larger AMIs. In a large multicenter trial, only 4 symptoms were associated with the diagnosis of AMI, and no symptoms that were associated with a non-AMI diagnosis.

Second Level Management of a Complex Case with Suspected Cardiac Amyloidosis: A Challenge for the Clinician

We report the clinical case report of a 67-year-old patient with diagnoses of hypertension, ischemic heart disease and a previous history of Acute Myocardial Infarction (AMI) and nonspecific signs and symptoms (general illness, weight loss, hyporexia, fever, impressive edema at the feet, systemic arterial hypotension). So, we performed a series of laboratory, radiological and instrumental examinations, but the clinical picture remained difficult to interpret.

Incidência da queixa de dor torácica como sintoma de infarto agudo do miocárdio em uma unidade de pronto-atendimento

BACKGROUND AND OBJECTIVES: Chest pain is one of the main reasons why individuals seek urgent and emergency services. It is a symptom that may suggest several pathologies, among which the acute coronary syndrome, which makes differential diagnosis difficult. The objective of this study was to identify the incidence of chest pain confirmed as acute myocardial infarction in an urgent care unit in the city of Joinville; and specifically to describe the epidemiological profile of patients with chest pain due to acute myocardial infarction, regarding gender, age, type of acute myocardial infarction and cardiac enzyme alterations; identify how individuals described the symptom; to recognize other factors causing chest pain and to know the incidence of chest pain related to non-cardiac causes. METHODS: Documentary study, descriptive and quantitative approach. RESULTS: The incidence of chest pain as a symptom of acute myocardial infarction corresponded to 1% of the sample, affecting males. Several other causes were pointed out stemmed from the international code of diseases to seek care for this complaint. CONCLUSION: The study evidenced the relevance of this complaint in emergency and urgent care units and the need to recognize the clinical manifestations and acute myocardial infarction screening for differential diagnosis.

Diarrhea as Atypical Symptom of Acute Myocardial Infarction

Diarrhea as Atypical Symptom of Acute Myocardial Infarction

High-Sensitivity Troponin Assays in Clinical Diagnostics of Acute Coronary Syndrome.

Nowadays, measurement of cardiac troponins (cTn) in patient plasma is central for diagnosis of patients with acute coronary syndrome (ACS). High-sensitivity (hs) immunoassays have been developed that can very precisely record slightly elevated and rising plasma concentrations of cTn very early after onset of clinical symptoms. Algorithms integrate measurements of hs-cTn at onset of clinical symptoms of acute myocardial infarction (AMI), and 1 or 3h after onset, to rule-in and rule-out AMI patients. More and more point-of-care (POC) cTn assays conquer the diagnostic market, but thorough clinical validation studies are required before potential implementation of such POC tests into hospital settings. This review provides an overview of the technical aspects, as well as diagnostic and prognostic use of cardiac troponins in AMI patients and in the healthy population.

Identificação da hora de início da sintomatologia de enfarte agudo do miocárdio

Background: Acute myocardial infarction is one of the leading causes of death in Portugal and worldwide. Several studies have shown a morning predominance of the onset of symptoms in this pathology. Objective: Describe the variation in onset of the infarction symptomatology and to analyze the average delay of admission in the emergency service of patients between 2015 and 2016 to a unit in northern Portugal. Methodology: Retrospective cross-sectional study. Fifty patients were studied, admitted to an emergency department diagnosed with acute myocardial infarction between 2015 and 2016 using clinical records. Results: The majority of participants were male (52%), with an average age of 79.6 years, presenting with hypertension (72%), dyslipidemia (54%), diabetes (46%), and obesity (20%). Onset time of acute myocardial infarction symptoms was generally between 6 a.m. and 12 p.m. (34%) and on average at 10 a.m. Conclusion: There was a predominance of symptom onset in the morning period

Recognition of acute myocardial infarction symptoms before admittance to hospital

Recognition of acute myocardial infarction symptoms before admittance to hospital

Time to hospital arrival among patients with acute myocardial infarction in China: a report from China PEACE prospective study.

AimsFew contemporary studies have reported the time between acute myocardial infarction (AMI) symptoms onset and hospital arrival, associated factors, and patient perceptions of AMI symptoms and care seeking. We sought to study these issues using data from China, where AMI hospitalizations are increasing.Methods and resultsWe used data from the China PEACE prospective AMI study of 53 hospitals across 21 provinces in China. Patients were interviewed during index hospitalization for information of symptom onset, and perceived barriers to accessing care. Regression analyses were conducted to explore factors associated with the time between symptom onset and hospital arrival. The final sample included 3434 patients (mean age 61 years). The median time from symptom onset to hospital arrival was 4 h (interquartile range 2–7.5 h). While 94% of patients reported chest pain or chest discomfort, only 43% perceived symptoms as heart-related. In multivariable analyses, time to hospital arrival was longer by 14% and 39% for patients failing to recognize symptoms as cardiac and those with rural medical insurance, respectively (both P < 0.001). Compared with patients with household income over 100 000 RMB, those with income of 10 000–50 000 RMB, and <10 000 RMB had 16% and 23% longer times, respectively (both P = 0.03).ConclusionWe reported an average time to hospital arrival of 4 h for AMI in China, with longer time associated with rural medical insurance, failing to recognize symptoms as cardiac, and low household income. Strategies to improve the timeliness of presentation may be essential to improving outcomes for AMI in China.Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT01624909.

Acute Myocardial Infarction Experience Among Mexican American Women.

Health disparities in cardiovascular disease risk factors affect a burgeoning segment of the U.S. population-Mexican American (MA) women. MAs experience disparities in the prevalence of heart disease risk factors. However, there are no studies describing acute myocardial infarction (AMI) symptoms unique to this Hispanic subgroup. The aim of the study was to describe MA women's AMI symptom experience. A qualitative descriptive design guided the study. Data were collected in semistructured interviews with eight MA women who reported having an AMI within the past 18 months. Data were analyzed using qualitative content analysis. The overall theme was "The nature of my AMI experience." This theme, composed of four categories, described their prodromal and AMI symptom experience: my perception of AMI, having a heart attack, AMI symptoms, and actions taken. No participants recognized prodromal or symptoms of AMI. Asphyxiatia (asphyxiating) and menos fuerza (less strength) were commonly described symptoms. Participants attributed both prodromal and AMI symptoms to noncardiac causes, self-managed symptoms, and delay in seeking health care. Findings suggest that community engagement through culturally tailored family-focused heart health education for MA women and their family members may improve recognition of prodromal symptoms.

Construction of core symptoms of acute myocardial infarction

Objective To explore the clinical core symptoms of acute myocardial infarction in Chinese cultural context, and to develop a checklist of acute myocardial infarction symptoms. Methods A list of clinical symptoms of acute myocardial infarction and the descriptive definition of each symptom were preliminary derived from literature review. On the basis of the Delphi experts enquiry method, a number of 35 clinical cardiology medical specialists and clinical nurse specialists around the country were recruited by standard strict selection. After 2 rounds of expert consultation, core symptoms of acute myocardial infarction were selected by these experts. Results A total of 14 symptoms were finally selected, including chest pain, fatigue (weakness) , irritability, palpitations, breathing difficulties, fear, left shoulder radiating pain, anxiety, nausea, vomiting, abdominal pain, right shoulder radiating pain, cold sweats and back pain. Conclusions Preliminary construction of the core symptoms of acute myocardial infarction with good positive coefficient and authority coefficients of experts was scientific and practical, which is helpful to improve identification and judgment acute myocardial infarction symptoms for both patients and medical staff. Key words: Signs and symptoms; Acute myocardial infarction; Delphi

Low level of knowledge of heart attack symptoms and inappropriate anticipated treatment-seeking behaviour among older Chinese: a cross-sectional survey

BackgroundPrehospital delay of acute myocardial infarction (AMI) is common globally, and Hong Kong—home of a rapidly ageing Chinese population—is not an exception. Seeking emergency medical care promptly is important for...

Effect of sulfonylureas on attenuation of electrocardiographic ST- segment elevation during an acute myocardial infarction in diabetics

Background: Sulfonylureas are primarily used in the treatment of diabetes mellitus act by inhibiting ATP sensitive potassium ATP (K-ATP) channels. Similar channels are also present are also present in heart venticular muscle. Previous studies reveal that these drugs are able to reduce the electrocardiographic ST- segment elevation changes during an acute myocardial infarction. Hence, the present study was designed to evaluate the attenuating effect of sulfonylureas on ST- segment elevation in diabetic patients presenting with acute myocardial infarction.Methods: This cross sectional study included 73 diabetic patients presenting with the signs and symptoms of acute myocardial infarction of less than 24 hours duration along with CPK levels of more than 25 IU/L. Of them 5 were excluded from the study. The remaining 68 patients were included in the study, out of which 36 patients were in the study group (sulfonylurea group), and 32 patients were in the control group (non-sulfonylurea group).Results: No statistically significant difference was seen in the demographic parameters like age, sex, duration of diabetes mellitus and CPK levels (p&gt;0.05). Among 68 patients 38 patients were diagnosed as STEMI. The mean magnitude of ST-elevation in the study group (n=16) was 2.3±0.12 and in control group (n=22) patients it was 3.7±0.33. The percentage of NSTEMI was significantly higher in study group compared to control. Statistically significant difference (p&lt;0.05) was seen only between CPK level of range 25 and 100IU/L and mean magnitude of ST-segment elevation in STEMI patients. Significant difference in the mean magnitude of ST-segment elevation was observed in case of females among the study and control groups (p&lt;0.05).Conclusions: Sulfonylureas drugs play a significant role in attenuation of ST-segment in diabetic patients presenting with acute myocardial infarction. Further, large multicentric studies are required to confirm the exact correlation between sulfonylureas and ST-segment.

Correlation between ST segment shift and cardiac diastolic function in patients with acute myocardial infarction

BackgroundDiastolic dysfunction is the early sign of myocardial ischemia that usually occurs earlier than ECG changes. Aim of the studyTo determine the existence of a correlation between ST segment shift and diastolic dysfunction among patients with AMI. MethodsFourty six patients with significant ST segment elevation or depression and having symptoms of acute myocardial infarction for <12 h were enrolled in this study. Patients were examined for serial ECG, cardiac enzymes, and echocardiography. ResultsThere was no significant correlation between ST segment elevation or depression and majority of the diastolic indices. Few diastolic parameters; such as, E/A ratio of the mitral valve and deceleration time of the tricuspid valve showed a direct correlation with the ECG changes. Whereas, the Tei Index of the LV function showed a borderline correlation to the ST segment elevation at discharge. ConclusionOverall, there was no correlation between either ST segment elevation or depression and the LV or RV diastolic function in patients with acute coronary syndrome (ACS). Improvement of the ST segment total score was associated with improvement of the diastolic function grades at discharge. Moreover, this association has shown an evidence of dose response relationship, the more improvement in total score at discharge the more improvement in diastolic function grade level.