Symptoms Of Myocardial Infarction Research Articles

Growth differentiation factor-15 — a new indicator of unfavorable prognosis in uncomplicated myocardial infarction

Aim. To evaluate the role of growth differentiation factor-15 (GDF-15) in long-term prognosis in patients with uncomplicated myocardial infarction (MI).Material and methods. The study included 118 patients with uncomplicated ST-elevation and non-ST-elevation MI. In addition to the routine examination, all patients were analyzed for GDF-15, as well as the N-terminal pro-brain natriuretic peptide (NT-proBNP) by enzyme immunoassay in the first 48 hours from the onset of MI symptoms. The changes in the patients' condition were assessed by questioning after 1, 3, 6, 12 months, as well as the analysis of medical records in the event of repeated cardiovascular events and deaths. The endpoints were cardiovascular death, hospitalization for recurrent MI, and/or unstable angina. To assess the value of quantitative variables in predicting recurrent cardiovascular events, the ROC analysis was used. The survival function of patients was assessed using the Kaplan-Meier method.Results. Twelve-month follow-up revealed 29 recurrent cardiovascular events, including 2 deaths and 8 recurrent MIs. GDF-15 was predictive of recurrent cardiovascular events with a sensitivity of 77,3% and a specificity of 56,2% (ROCAUC, 0,7±0,065 (95% confidence interval (CI), 0,572-0,827), p=0,004). Patients with GDF-15 ≥2,075 ng/mL had a higher risk of recurrent cardiovascular events (hazard ratio (HR), 3,4 (95% CI, 1,342-8,613), p=0,005). Another prognostic factor influencing the rate of recurrent cardiovascular events was NT-proBNP. An NTproBNP level ≥578 pg/mL was associated with an increased risk of cardiovascular death and rehospitalization for unstable angina and recurrent MI (HR, 4,3 (95% CI 1,828-10,239), p=0,00019).Conclusion. The combined increase in GDF-15 ≥2,075 ng/mL and NT-proBNP ≥578 pg/mL in patients with uncomplicated MI increases the risk of recurrent cardiovascular events over the next 12 months (HR, 4,5 (95% CI, 2,087-9,736), p=0,00018).

Patient Denial of Myocardial Infarction in the Prehospital Phase: Prevalence and Correlates.

Limited knowledge exists regarding patients' denial of myocardial infarction (MI) before hospitalization for an MI. The aim of this study was to determine the prevalence and correlates of denial of MI in the prehospital phase of a confirmed MI. This secondary analysis included 166 hospitalized patients (mean [SD] age, 54.1 [10.5] years) who developed MI outside a healthcare facility and had high congruence between their experienced and expected symptoms. Measurements included the Denial subscale of the Brief COPE Inventory, the modified Response to Symptoms Questionnaire, and a Likert scale measuring perceived risk for MI. Patients who arrived at a hospital at least 1 hour after the onset of their symptoms were considered to have prolonged prehospital delay. Despite their high symptom congruence, 77% of patients denied the possibility of having an MI before hospitalization. The lower denial group was characterized by cardiac history, whereas the higher denial group was distinguished by nonsmoking, a lower perceived risk of MI, less anxiety at symptom onset, and more concerns about seeking medical help. Compared with the lower denial group, patients in the higher denial group were more likely to underestimate the seriousness of their symptoms and delay seeking medical help. The higher denial group responded to symptoms in a more passive manner (eg, waiting), whereas the lower denial group showed a more problem-solving approach (eg, contacting emergency services). Denial of MI is highly prevalent in the prehospital phase and is negatively linked with cognitive, emotional, and behavioral responses to MI symptoms.

Mind the Gap: Model-Based Switching from Selatogrel to Maintenance Therapy with Oral P2Y12 Receptor Antagonists.

Background: The P2Y12 receptor antagonist selatogrel is being developed for subcutaneous self-administration with a ready-to-use autoinjector at the onset of acute myocardial infarction (AMI) symptoms. The unique pharmacological profile of selatogrel (fast, potent, and short-acting) can bridge the time gap between the onset of AMI and first medical care. A clinical Phase 1 study showed a time-dependent pharmacodynamic interaction between selatogrel and loading doses of clopidogrel and prasugrel. As treatment switching is a common clinical practice, the assessment of subsequent switching from a clopidogrel loading dose to the first maintenance dose of oral P2Y12 receptor antagonists is highly relevant. Objectives: Model-based predictions of inhibition of platelet aggregation (IPA) for the drugs triggering pharmacodynamic interactions were to be derived to support clinical guidance on the transition from selatogrel to oral P2Y12 receptor antagonists. Methods: Scenarios with selatogrel 16 mg administration or placebo followed by a clopidogrel loading dose and, in turn, prasugrel or ticagrelor maintenance doses at different times of administration were studied. Population pharmacokinetic/pharmacodynamic modeling and simulations of different treatment scenarios were used to derive quantitative estimates for IPA over time. Results: Following selatogrel/placebo and a clopidogrel loading dose, maintenance treatment with ticagrelor or a prasugrel loading dose followed by maintenance treatment quickly achieved sustained IPA levels above 80%. Prior to maintenance treatment, a short time span from 18 to 24 h was identified where IPA levels were predicted to be lower with selatogrel than with placebo if clopidogrel was administered 12 h after selatogrel or placebo. Predicted IPA levels reached with placebo alone and a clopidogrel loading dose at 4 h were consistently lower than with selatogrel administration, followed by a clopidogrel loading dose at 12 h. If a clopidogrel loading dose is administered at 12 h, selatogrel maintains higher IPA levels up to 16 h. IPA levels are subsequently lower than on the placebo until the administration of the first maintenance dose. Conclusions: Model-based predictions informed the transition from selatogrel subcutaneous administration to oral P2Y12 therapy. The application of modeling techniques illustrates the value of employing pharmacokinetic and pharmacodynamic modeling for the simulation of various clinical scenarios of switching therapies.

A man in his sixties with acute chest pain.

Chest pain is a frequent symptom of acute myocardial infarction, but the cause is not always coronary atherothrombosis. We present a case where the patient himself had made a correct non-cardiac diagnosis, but this was initially overlooked by the doctor. A man with a history of cardiac infarction was admitted with acute chest pain and troponin elevation. Electrocardiogram suggested ST elevations, echocardiography showed a possible slight hypokinesia, and we primarily suspected an acute coronary syndrome. However, invasive coronary angiography was negative and a primary acute myocardial infarction was less likely. A renewed interview revealed that the patient had worked with a propane burner indoors without adequate ventilation. The patient himself suspected carbon monoxide poisoning. Arterial blood gas showed HbCO 27.4%, which was unfortunately overlooked initially. The patient had carbon monoxide poisoning with symptoms of dizziness, hand ataxia and myocardial ischaemia. He received 100% oxygen and HbCO was normalised. The imbalance between oxygen demand and supply resulted in a type 2 cardiac infarction. A thorough medical history is crucial for correct diagnosis but can unfortunately be missed on a busy shift. This case illustrates the importance of the patient's own diagnostic assumption.

Pre-hospital delays among patients with acute coronary syndrome in the Russian Federation: a multicentre prospective observational cohort study (the AMIR Study)

ObjectiveThis study aimed to describe total pre-hospital delays (symptom onset to admission), patient delays (symptom onset to calling for help), and transport delays (calling for help to admission) experienced by patients with acute coronary syndrome (ACS) in Russia and identify factors associated with longer delays.MethodsA prospective observational cohort study of ACS patients with myocardial infarction recruited in hospitals providing percutaneous coronary intervention (PCI) and those that do not (non-PCI) in 13 regions and at multiple levels of the health system in Russia. Data were collected on pre-hospital delays between symptom onset and admission to the hospital providing definitive treatment, divided into patient delay (time between symptom onset and calling for help) and transport delay (time between calling for help and admission).ResultsOf 902 patients, 701 (77.7%) had full data on pre-hospital delays. The median total pre-hospital delay in our study was 5.1 h, the median patient delay was 1.5 h, and the median transport delay was 2.1 h. Patient delays did not differ by age and sex, although having an ST-elevation myocardial infarction (STEMI) and certain symptom presentations, including severe pain, reduced delays. Transport delays were markedly reduced in those transported by emergency medical services (EMS) and taken directly to the hospital of definitive treatment (rather than to one closer but unable to offer PCI).Although transport delays were reduced in those using EMS, just half of the patients using EMS had a transport delay of <2 h (first medical contact to admission). Among all patients taken directly to the hospital by EMS, 70% were STEMI patients. Of these STEMI patients, 78% had a transport delay of 2 h or more. Among these patients, only 16.0% received thrombolysis in the ambulance. As expected, regional differences were apparent with all types of delay, with the greatest variation found in transport delays.ConclusionDelays are currently longer than the European Society of Cardiology guidelines for STEMI patients and other severe cases. Reducing patient delays will reduce overall delays. Transport delays are inevitable in many regions of Russia, but better triage of patients, increased use of EMS, and early thrombolysis in EMS, particularly for STEMI patients facing excessive transport delays, will reduce delays and buy time before PCI.

Early prediction of left ventricular function improvement in patients with new-onset heart failure and presumed non-ischaemic aetiology

ObjectivesTo determine baseline characteristics predictive of left ventricular ejection fraction (LVEF) recovery in patients diagnosed with heart failure with reduced ejection fraction (HFrEF) and presumed non-ischaemic aetiology.MethodsWe prospectively recruited patients...

Knowledge on heart disease of the person with ischemic heart disease

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Instruments that allow us to measure the users' knowledge about their health can be useful in clinical practice to allow adjusting interventions, quantifying health gains and developing cost-effective interventions. Purpose To determine knowledge about heart disease among the population with diagnosed ischemic heart disease. Methods Cross-sectional, descriptive study using a sequential sample of patients with ischemic heart disease admitted between May 2nd and July 30th, 2022 at the cardiology service of the Hospital Centre of our city. A self-administered questionnaire was developed and applied to 165 patients, encompassing several dimensions: sociodemographic characteristics, clinical history, lifestyle, number of hospitalizations due to heart disease and characterization of the current admission. An instrument was used to determine knowledge about heart disease (Questionário de Avaliação de Conhecimentos em Doença Cardíaca: QACDC - Questionnaire for the Assessment of Knowledge in Heart Disease), the Medical Term Recognition Test (METER) to assess literacy and the Hospital Anxiety and Depression Scale (HADS). Patients were assessed during their stay at the hospital unit where they had been admitted due to an acute illness or for elective procedures. Using, preferably, parametric tests, we studied the association between the average score obtained in the QAC-DC and the variables studied. Results Women, the less educated and those with inadequate literacy levels were the groups with the lowest levels of knowledge. Regarding the areas of knowledge, the least recognized cardiovascular risk factors were the family history of ischemic heart disease (recognized by 86%), diabetes mellitus (recognized by 73%) and gender (marked by 19% of respondents). The most frequently identified symptom of heart disease was chest discomfort (92%), followed by difficulty breathing or shortness of breath (84%), while jaw, neck or interscapular discomfort was only recognized by 54% of respondents. Symptoms of stroke and acute myocardial infarction were confused by 88% of the sample. Conclusions There are important gaps in some areas of knowledge about heart disease among patients with ischemic heart disease. These gaps are particularly important in certain patient subgroups. Health intervention strategies must be sensitive to these data. The QAC-DC knowledge assessment instrument proved to be reliable, valid and applicable in clinical practice.

Calcineurin signaling promotes takotsubo syndrome

Takotsubo syndrome (TTS) is an acute heart failure syndrome that mimics the symptoms of acute myocardial infarction and is often preceded by emotional and/or physical stress. There is currently no treatment for TTS. Here we show that injection of 2.5 mg kg−1 of epinephrine (EPI) into mice recapitulates numerous features of human TTS, including increased myocardial damage and mortality in males. Gene set enrichment analysis of myocardial RNA sequencing after EPI injection revealed significant enrichment of calcineurin-dependent pro-inflammatory gene networks, which was more pronounced in male than in female mice, in agreement with observed sex discrepancies in the mouse phenotype. An increase in calcineurin activity was detected in the circulating cells of patients with TTS, suggesting a systemic nature of the syndrome. Preventive and therapeutic treatment of mice injected with EPI using calcineurin inhibitors cyclosporine and tacrolimus improved heart function and reduced myocardial injury. Our findings suggest that calcineurin inhibition could be a potential therapy for TTS.

Associated Factors with Delay in Prehospital Myocardial Infarction

Aims: The aim of this study is to review and analyze the associated factors that contribute to delay in prehospital myocardial infarction, based on published literature.
 Methodology: A systematic literature review was conducted to identify and analyze the associated factors with delay in prehospital myocardial infarction (MI). Relevant studies published between 2003 and 2022 were searched using predefined search terms in electronic databases. Study selection involved screening titles and abstracts, followed by a full-text evaluation of potentially relevant articles. Data from selected studies were extracted and analyzed qualitatively to identify common patterns and associations. The quality of included studies was assessed using appropriate tools, and the findings were synthesized narratively.
 Results: Sociodemographic and clinical factors, such as older age, female gender, lower socioeconomic status, and comorbidities like diabetes and hypertension, were consistently associated with delayed presentation to healthcare facilities. Individuals with a history of psychiatric disorders, including depression and anxiety, were also more likely to experience delays in seeking medical attention for MI symptoms. Psychosocial and behavioral factors, such as fear, denial, low health literacy, and misconceptions about the seriousness of the condition, further impeded timely recognition and response. Additionally, system-level factors, including inadequate infrastructure, limited resources, and overcrowding in emergency departments, contributed to diagnostic delays.
 Conclusion: The delay in prehospital myocardial infarction (MI) diagnosis is a significant issue influenced by various factors. Sociodemographic, clinical, psychosocial, and system-level factors contribute to this delay. Addressing these factors through targeted interventions, education, and improved access to healthcare can help mitigate delays, improve timely recognition, and enhance outcomes for individuals experiencing MI.

Diagnostic momentum in physical therapy clinical reasoning.

Diagnostic momentum refers to ruling in a particular diagnosis without adequate evidence. As the field of physical therapy continues to transition more towards autonomous practitioners with direct access, there is a need to identify the effect of a physician diagnosis on a therapist's examination and treatment. The purpose of this study was to identify if diagnostic momentum exists in physical therapy and whether this phenomenon could affect the ability of the therapist to identify clinical red flags. An online survey with randomized case scenarios was completed by 75 licensed practicing physical therapists. Participants received one of two scenarios: a case vignette where the patient was referred to physical therapy for left shoulder pain and presented with 'red flags' indicative of myocardial infarction, or a similar vignette with additional results from an exercise stress test that ruled out myocardial infarction. The subjects were asked if they would 'treat' or 'refer' to another healthcare provider and the reason behind their decision. Independent t-tests and χ2 analyses were conducted to understand the differences between the groups. A thematic analysis was used to explore the therapists' responses regarding the reasoning for their decision. There was no significant difference in clinical decision making based on age, gender, years of experience, advanced certification, primary caseload or primary practice setting. Among those who received the case without the stress test, 31.4% of participants indicated that they would refer, compared to 12.5% of the participants that had the additional stress test result included within their case. The presence of the negative stress test was indicated as the main reason for choosing to treat without referral by 65.7% of the subjects that received the additional stress test result. This study suggests that practicing physical therapists may be influenced by diagnostic decisions made by other clinicians, causing them to overlook signs and symptoms of possible myocardial infarction.

Detection of Myocardial Infarction Using Hybrid Models of Convolutional Neural Network and Recurrent Neural Network

Myocardial Infarction (MI) is the death of the heart muscle caused by lack of oxygenated blood flow to the heart muscle. It has been the main cause of death worldwide. The fastest way to detect MI is by using an electrocardiogram (ECG) device, which generates graphs of heartbeats morphology over a certain period of time. Patients with MI need fast intervention as delay will lead to worsening heart conditions or failure. To improve MI diagnosis, much research has been carried out to come up with a fast and reliable system to aid automatic MI detection and prediction from ECG readings. Recurrent Neural Network (RNN) with memory has produced more accurate results in predicting time series problems. Convolutional neural networks have also shown good results in terms of solving prediction problems. However, CNN models do not have the capability of remembering temporal information. This research proposes hybrid models of CNN and RNN techniques to predict MI. Specifically, CNN-LSTM and CNN-BILSTM models have been developed. The PTB XL dataset is used to train the models. The models predict ECG input as representing MI symptoms, healthy heart conditions or other cardiovascular diseases. Deep learning models offer automatic feature extraction, and our models take advantage of automatic feature extraction. The other superior models used their own feature extraction algorithm. This research proposed a straightforward architecture that depends mostly on the capability of the deep learning model to learn the data. Performance evaluation of the models shows overall accuracy of 89% for CNN LSTM and 91% for the CNN BILSTM model.

Optimal reperfusion time in patients with non-ST elevation acute myocardial infarction and low ischemic risk

The aim of the study was to identify the optimal time window for performing effective percutaneous coronary reperfusion in patients with non-ST-segment elevation acute myocardial infarction (NSTEMI) who are part of the low ischemic risk group. 252 patients with NSTEMI and low ischemic risk who underwent coronary angioplasty up to 30 days after the onset of the infarction were evaluated the second day post-procedurally and at a distance of 6 months. The general group was randomized depending on the echocardiographic evolution. 131 patients with unfavorable evolution and 121 with more complete restoration of left ventricular contractile function. The time windows from the onset of myocardial infarction symptoms in which percutaneous myocardial reperfusion was applied were studied. Following the study, the time interval of 73 hours -14 days proved to be optimal in which a more favorable clinical and echocardiographic evolution is ensured.

Investigation of Cardioprotective Activity of Silybin: Network Pharmacology, Molecular Docking, and In Vivo Studies

AbstractThe abundant health benefits of silybin are known to benefit people with myocardial infarction (MI). However, their mechanisms of action are not precise. To address this problem, network pharmacology was used to identify the various components that can be utilized to treat this condition, and an in vivo study was conducted to evaluate the cardioprotective effect in MI rats. Genes associated with silybin and MI targets were extracted, and overlapping genes between silybin‐associated genes and MI targets were identified using Venn diagrams. Using Cytoscape, we built, visualized, and analyzed a network of compounds and genes with pathways. Protein‐protein interaction network (PPI), gene ontology (GO) function enrichment, and Kyoto Encyclopedia of Genes, and Genomes (KEGG) pathway enrichment analyses of the core targets were performed to predict its mechanism. A molecular docking study assessed the affinity between silybin and the top three genes. ECG pattern, serum CK‐MB, LDH, serum and heart tissue antioxidants, SOD and catalase in isoproterenol‐induced MI rats were used to test the cardioprotective effect of silybin. Silybin‐related genes (114) and MI‐related genes (1800) were identified, and 74 genes overlapped, in which the degrees of AKT1, TNF‐α and IL‐6 were higher than those of other targets are the disease target precisely. The enrichment of the gene set‐based indicated that the PI3K‐Akt, TNF‐α, IL‐17, VEGF, and HIF‐1 signaling pathways were significantly involved in the mechanisms of silybin against MI. The QRS complex of the ECG of silybin‐treated MI rats was restored to normal ECG and significantly increased serum (p<0.0001***) and heart tissue (p<0.0001***) SOD and serum (p<0.001**) and heart tissue (p<0.001**) catalase compared to MI rats. This study embodies the complex network relationship of multi‐target and multiple pathways of silybin in the treatment of MI and provides a novel method for further research on the mechanism of silybin. It has been suggested that silybin alleviates the symptoms of MI by improving antioxidant levels through the PI3K‐Akt/HIF‐1 pathway.

Coronary Microvascular Dysfunction: Epidemiology, Clinical Presentation, Diagnosis and Treatment

In a significant number of patients with symptoms of angina pectoris or myocardial infarction with ischemic changes in the myocardium, according to the results of instrumental research methods, there is no hemodynamically significant stenosis of the coronary arteries. In these cases, vasospastic angina or microvascular dysfunction is considered the cause of coronary heart disease. Coronary microvascular dysfunction is caused by several pathological mechanisms that cause structural and functional disorders in the microvascular bed of the heart. Clinical groups of coronary microvascular dysfunction include angina pectoris and myocardial ischemia without obstructive coronary artery disease (primary coronary microvascular dysfunction), in combination with coronary atherosclerosis, with myocardial damage and iatrogenic nature. Diagnostics of microvascular disorders is carried out on the basis of the results of non-invasive and invasive methods, which make it possible to clarify the nature of the changes and choose an effective nondrug and drug treatment. The prognosis for coronary microvascular dysfunction is poor, due to the development of cardiovascular complications and death, a high risk of disability, and a decrease in the quality of life of patients.

Clinical Outcomes of Early Versus Delayed Discharge After Primary Percutaneous Coronary Intervention

BACKGROUND: Heart disease is the most significant cause of death worldwide and ST- elevation myocardial infarction (STEMI) is a prime cause of death in developing nations. PCI has progressed to the point where overnight monitoring is unnecessary for some patients because of its increased safety and effectiveness. Improved patient satisfaction, shorter hospital stays, and more efficient use of healthcare resources are the key advantages of same-day release following PCI. PCI has always been viewed as an inpatient or short-stay surgery, requiring up to 24 hours of observation time. The purpose of this research was to make comparison of the outcomes of early and delayed discharge strategy after primary PCI in patients with STEMI and to establish the frequency of early discharge following primary PCI in patients having STEMI.
 METHODOLOGY: The study was conducted in Cardiology department of Punjab Institute of Cardiology, Lahore from August 10, 2020 to February 10, 2021. Total 200 patients presenting with STEMI were enrolled in the study. Patients underwent primary PCI by a single team with assistance of researcher. If patients were discharged within 36 hours, then earlier discharge was labeled. Patients were asked to present after 1 month in OPD. Patients were advised to present in case they feel similar symptoms of myocardial infarction, stroke, heart failure or mortality. The collected data were analysed statistically by using SPSS v25.0. Both groups were compared using chi-square test for clinical outcome. Data were stratified for age, gender, h/o diabetes, hypertension, smoking and duration of symptoms. Post-stratification, both groups were compared by using chi-square test for clinical outcome in each strata. A p-value ?0.05 was taken as significant.
 RESULTS: Total 200 patients presenting with STEMI and underwent primary PCI were enrolled in this study. There were 146(73.0%) were males and 54(27.0%) were females. The mean age of patients was 50.6±19.2 years. Out of 200 patients with STEMI, 86(43.0%) were early discharged and 114(57.0%) had delayed discharged.
 CONCLUSION: This study showed that early discharge is also safe and feasible among patients with STEMI who underwent PCI as compared to delayed discharge. Early discharge may help in lowering down healthcare costs for Primary PCI service providers

Myocardial Infarction Signs and Symptoms: Females vs. Males.

Cardiovascular disease is the number one killer of females in the United States today, and myocardial infarction (MI) plays a role in many of these deaths. Females also present with more "atypical" symptoms than males and appear to have differences in pathophysiology underlying their MIs. Despite both differences in symptomology and pathophysiology being present in females versus males, a possible link between the two has not been studied extensively. In this systematic review, we analyzed studies examining differences in symptoms and pathophysiology of MI in females and males and evaluated possible links between the two. A search was performed for sex differences in MI in the databases PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Complete, Biomedical Reference Collection: Comprehensive, Jisc Library Hub Discover, and Web of Science. Seventy-four articles were ultimately included in this systematic review. Typical symptoms for both ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) such as chest, arm, or jaw pain were more common in both sexes, but females presented on average with more atypical symptoms such as nausea, vomiting, and shortness of breath. Females with MI also presented with more prodromal symptoms such as fatigue in days leading up to MI, had longer delays in presentation to the hospital after symptom onset, and were older with more comorbidities than males. Males on the other hand were more likely to have a silent or unrecognized MI, which concurs with their overall higher rate of MI. As they age, females have a decrease in antioxidative metabolites and worsened cardiac autonomic function than male. In addition, at all ages, females have less atherosclerotic burden than mles, have higher rates of MI not related to plaque rupture or erosion, and have increased microvasculature resistance when they have an MI. It has been proposed that this physiological difference is etiologic for the male-female difference in symptoms, but this has not been studied directly and is a promising area of future research. It is also possible that differences in pain tolerance between males and females may play a role in differing symptom recognition, but this has only been studied one time where females with higher pain thresholds were more likely to have unrecognized MI. Again, this is a promising area for future study for the early detection of MI. Finally, differences in symptoms for patients with different atherosclerotic burden and for patients with MI due to a cause other than plaque rupture or erosion has not been studied and are both promising avenues to improve detection and patient care in the future.

Implementation of high-sensitivity troponin with a rapid diagnostic algorithm reduces emergency department length of stay for discharged patients

IntroductionHigh sensitivity troponin (hs-cTn) and diagnostic algorithms are used to rapidly triage patients with symptoms of acute myocardial infarction in emergency departments (ED). However, few studies have evaluated the impact of simultaneously implementing hs-cTn and a rapid rule-out algorithm on length of stay (LOS). MethodsWe assessed the impact of transitioning from contemporary cTnI to hs-cTnI in 59,232 ED encounters over three years. hs-cTnI was implemented with an orderable series that included baseline, two-, four-, and six-hour specimens collected at provider discretion and operationalized with an algorithm to calculate the change in hs-cTnI from baseline and provide interpretations of “insignificant”, “significant,” or “equivocal.” Patient demographics, results, chief complaint, disposition, and ED LOS were captured from the electronic medical record. ResultscTnI was ordered for 31,875 encounters prior to hs-cTnI implementation and 27,357 after. The proportion of cTnI results above the 99th percentile upper reference limit decreased from 35.0% to 27.0% for men and increased from 27.8% to 34.8% for women. Among discharged patients, the median LOS decreased by 0.6 h (0.5–0.7). LOS among discharged patients with a chief complaint of chest pain decreased by 1.0 h (0.8–1.1) and further decreased by 1.2 h (1.0–1.3) if the initial hs-cTnI was below the limit of quantitation. The rate of acute coronary syndrome upon re-presentation within 30 days did not change post-implementation (0.10% versus 0.07%). ConclusionImplementation of an hs-cTnI assay with a rapid rule-out algorithm decreased ED LOS among discharged patients, particularly among those with a chief complaint of chest pain.

The Impact of Illness Perception on Delay in Seeking Medical Help in Patients with Acute Chest Pain: A Cross-sectional Study in the United Arab Emirates

Background: The concern of contracting COVID-19 has prevented numerous individuals with ambiguous myocardial infarction symptoms from seeking medical attention, leading to delayed presentation and treatment of acute coronary syndrome (ACS). This delay could increase the risk of long-term consequences. Aim: The aim of this study is to evaluate the impact of illness perception on delay in seeking medical help in patients with acute chest pain in UAE during COVID-19 pandemic. Methods: A descriptive cross-sectional design was used. Results: A total of 222 in-patients participated in the study, with an average age of 54.3 years (SD=14, Range= 20-86). The average score of illness perception was 5.66 (SD=0.92), which indicates that CVD was perceived as moderately threatening to physical and emotional status. Univariate analysis showed that illness coherence having previous cardiac catheterization, diabetes and asthma were factors associated with delay in seeking medical services. The linear regression showed that college education was a strong predictor of delay, while a history of asthma and undergoing cardiac catheterization were independent predictors of shorter delay. Conclusion: Illness coherence perception and time of seeking medical help are correlated. In addition, illness perception of personal control is low, which indicates the need for educational intervention. Other clinical factors also impact patients’ decisions, such as previous cardiac intervention and comorbidity, highlighting the target group for further attention from the healthcare team.

Importance of the Multimodality Evaluation of a Double-chambered Right Ventricle for Surgical Indications on Admission for Acute Myocardial Infarction.

We treated a female patient known to have a double-chambered right ventricle (DCRV) who presented with symptoms of an acute myocardial infarction (AMI). Emergent coronary artery catheterization revealed acute right coronary artery (RCA) occlusion and proximal left anterior descending (LAD) stenosis. We performed percutaneous coronary intervention (PCI) for the RCA occlusion. Right heart catheterization revealed a pressure gradient across the mid-RV of 58 mmHg. Computed tomography and magnetic resonance imaging revealed no other congenital cardiac abnormalities. She underwent surgical repair of the RV stenosis and coronary artery bypass surgery for LAD stenosis.

Diabetes mellitus is an independent predictor of obstructive coronary artery disease in patients presenting with atrial fibrillation and elevated troponin.

Atrial fibrillation can present with symptoms of myocardial infarction and elevated troponin, even in the absence of obstructive coronary artery disease (CAD). We sought to determine the characteristics that predict underlying obstructive CAD. Obstructive CAD was far more likely in those with troponin elevation. In those with elevated troponin, diabetes mellitus was an independent predictor of obstructive CAD.