Syndrome In Young Patients Research Articles

Deficiency of Klotho protein as a cause of linked angina in young patients with thoracalgic phenotype of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is one of the most common diagnoses in therapeutic practice. Different manifestations of GERD represent different phenotypes of the disease with unique predisposing cofactors and individual pathophysiology. In the continuum of the proposed paradigm, chest pain syndrome in patients with gastroesophageal reflux stands out as a separate phenotype of GERD. Traditionally it was believed that the chest pain in young patients with GERD was not angina. Objective — to study the levels of Klotho protein and nitric oxide in the blood serum of patients with GERD and chest pain (thoracalgic phenotype of GERD). Materials and methods. 64 patients with GERD were prospectively examined, including 27 patients with the thoracalgic phenotype of GERD. The Klotho protein was determined in blood serum by the enzyme immunoassay, the metabolism of NO in the blood plasma was assessed by the Griess test. All patients underwent video esophagogastroscopy, transthoracic echocardiography and 24­Hour Holter electrocardiographic monitoring. Descriptive and nonparametric statistics methods were used in the study. Results. An evaluation of the chest pain syndrome in young patients with GERD revealed a high incidence of linked angina — 25.9%. A decrease in the Klotho protein and NO levels in the blood of patients with GERD and linked angina was observed compared to patients with uncomplicated GERD with pseudo­­coronary pain. The obtained result showed a direct relationship between the concentrations of Klotho protein and NO. Low levels of these parameters in patients with GERD and linked angina reflect endothelial dysfunction and lead to coronary artery spasm mediated by reflux. Conclusions. Linked angina occurs in a quarter of young patients with the thoracalgic phenotype of GERD. The basis of this phenomenon is a decrease in NO synthesis due to endothelial dysfunction, which develops against the background of the Klotho protein deficiency.

Myocardial infarction with non-obstructive coronary arteries in a young seropositive woman with human immunodeficiency virus: a case report and review of the literature

BackgroundElevated susceptibility to acute myocardial infarction and various cardiovascular diseases has been observed in individuals infected with the human immunodeficiency virus compared with the uninfected population, as demonstrated in numerous studies. The precise mechanism by which human immunodeficiency virus infection heightens the risk of acute myocardial infarction remains elusive. The manifestation of acute coronary syndrome in young patients with human immunodeficiency virus may deviate from the typical, displaying distinct pathophysiological and clinical characteristics. The occurrence of myocardial infarction with non-obstructive coronary arteries in young patients with human immunodeficiency virus poses diagnostic and treatment challenges.Case presentationWe present the case of a 46-year-old African woman with no traditional atherosclerotic risk factors. She was diagnosed with human immunodeficiency virus-1 infection 2 years prior to her current admission for chest pain. Her troponin levels were elevated, suggestive of acute coronary syndrome. Although coronary angiography ruled out coronary artery stenosis, it revealed mild myocardial bridging in the left anterior descending artery. Cardiac magnetic resonance imaging confirmed myocardial infarction, indicating a myocardial infarction with non-obstructive coronary arteries with an apical thrombus in the left ventricle. Following medical treatment, the patient experienced resolution of chest pain and improvement in ST-segment elevation.ConclusionsIn young female patients without traditional risk factors, human immunodeficiency virus infection is a possible etiological factor for myocardial infarction with non-obstructive coronary arteries. The likely pathophysiological pathway is superficial endothelial cell denudation as a result of chronic inflammation and immune activation.

What if youth is not enough? Acute coronary syndrome in young patients

Abstract Funding Acknowledgements None. Background Acute Coronary Syndromes (ACS) are the leading cause of mortality in Spain. Further research is needed in order to know risk factors and outcomes in young patients so that medicians could optimize their management and prevention. Purpose Identifying risk factors, clinical characteristics and short-term outcomes in Acute Coronary Syndrome in patients aged 40 and under. Methods A retrospective analysis of patients under 40 years of age who were admitted for ACS, out of 3,859 ACS admissions in Cardiology Intensive Care Unit (CICU) in our hospital between 2012 and 2022. Results 67 patients (1.73%) were included, most of them were males (83.6%). Baseline characteristics are summarized in Table 1. 77.6% had hypertension (HTA), 22.4% had diabetes (DM) and 34.3% had dyslipidemia (DLP). 79.1% were smokers, 9.1% had a history of alcoholism and 29.9% were cocaine users. None of them had a history of stroke, atrial fibrillation (AF). Only 3% had ischemic heart disease. 68.7% of them were ST-elevation myocardial infarction (STEMI) and inferior STEMI was the most common (38.7%). In anterior STEMI (22 patients), 15 had a severe lesion in the mid-left anterior descending artery (LAD), and 6 in the left main stem (LM). Single-vessel disease was the most common (70.8%), with 3-vessel disease in 4.6%. 75.8% received percutaneous coronary intervention (PCI), and 3% underwent bypass surgery. During admission, 10.5% progressed to Killip class III-IV. The ICU mortality was 1.5%. 9% received vasoactive drugs and 4.5% were intubated. Non-invasive ventilation was used in 3% and high-flow nasal cannula oxygen therapy in 5.3%. 3% received intra-aortic balloon pump support and 1.5% underwent dialysis or ultrafiltration. 4.5% received an implantable cardioverter-defibrillator (ICD), although none of them developed bundle branch block or atrioventricular node block, nor AF. After discharge, 11.1% had recurrent ACS, and up to 5.6% underwent PCI again, with a mortality rate of 11.8%. Conclusion Approximately 2% of ACS occur in people younger than 40 years of age. Substance abuse (smoking, cocaine and alcoholism) becomes more prevalent in this group. Prevalence of comorbidities (such as diabetes and nephropathy) are lower, making them less prone to short-term heart failure. However, they are more susceptible to recurrent ischemic events. There is a high incidence of inferior STEMI and LM-STEMI. For these reasons, medicians may need to find out a substance abuse in this group and further research into other risk factors, such as coronary disease family history.Basal characteristicsClinical evolution of patients

Unusual Presentation of Acute Coronary Syndrome in a 22-Year-Old Male with Juvenile Idiopathic Arthritis: A Case Report

This case report documents the clinical journey of a 22-year-old male who was initially diagnosed with Rheumatoid Arthritis (RA) and later, at the age of 11, with Juvenile Idiopathic Arthritis (JIA). The patient manifested atypical symptoms, primarily marked by sudden and intense chest pain accompanied by sweating, leading to a collapse during his emergency room visit. Medical evaluation revealed an extensive myocardial infarction affecting the anterior wall. The patient underwent a successful percutaneous coronary intervention targeting the left anterior descending artery. This case underscores the rare incidence of acute coronary syndrome in young patients with a history of JIA.

Mild post-COVID syndrome in young patients

Many COVID-19 survivors suffer from post-COVID syndrome, which significantly worsens the quality of life. Its presentation is quite diverse, with cognitive disorders being of particular importance. Liver injury due to the direct virus action and the treatment of the new coronavirus infection can persist for a long time during the recovery period and lead to hyperammonemia, which can cause cognitive disorders, including minimal hepatic encephalopathy. To study cognitive disorders in post-COVID syndrome and the possibility of their treatment with L-ornithine-L-aspartate. The study included 30 students from 18 to 24 years old who had COVID-19 and decreased attention, memory impairment, and other cognitive disorders inherent in hepatic encephalopathy of latent (grade 0) or mild (grade 1) severity, without pronounced impairment of intelligence, memory, speech, and learning ability. Hyperammonemia, elevated alanine aminotransferase, aspartate aminotransferase, and ã-glutamyl transpeptidase, signs of hepatic encephalopathy according to psychometric tests, were reported in young people. All patients in the study were treated with L-ornithine-L-aspartate to correct the ammonia blood level and improve signs of hepatic encephalopathy and the general condition. An improvement in the objective findings, liver enzymes, a decrease in ammonia level, and an improvement in testing results for changes in cognitive functions were reported.

Hepatorenal and renocardial syndrome in young patients with acute glomerulonephritis

In this paper we discuss classical types of acute glomerulonephritis in young adults, when the intake of paracetamol and diclofenac led to a dysfunctional and organic liver injury, at the same time it negatively affected the course of acute glomerulonephritis. To study the characteristics of the development of acute reno-cardial syndrome (ARCS) Goal: Assessment of cause and effect relations of renal, hearts and liver injuries in young adults in acute post-streptococcal glomerulonephritis (APSG). With acute nephritic syndrome (ANS) complicated by acute kidney injury (AKI) and without it, to identify the role of the etiological factor on the course of APSG. Methods and Material: 220 male patients with APSG with ANS aged 18-20 were examined. The patients were divided into 2 groups based on the functional state of kidneys. The first group included 140 patients with APSG without ANS, the second group included 80 patients with AKI. Results: Out 66 patients had subclinical liver injury, which resulted from the effect of antipyretic hepatotoxic drugs taken in the initial stage of the disease. Due to the toxic and immunological liver injury, levels of transaminases increase, and albumin levels decrease. These changes occur along with the development of APSG and are correlated with some laboratory values. Impairment of cardiovascular function was observed in all 220 patients. ECG and Echocardiography studies conducted during the cardiac asthma attacks occurred as a decrease of voltage, broadening of the P wave, lengthening of the PQ interval, broadening of the QRS complex, dilatations of the right and left atrium. The severity of clinical manifestations of AKI and ARCS correlates with the degree of macrohematuria, GFR decrease, complement C3 fraction, monocyte. Conclusion. In APSG liver injury has a toxicoallergic character. Frequency of liver injury depends on specific features of a particular organism, it does not depend on the dose of the taken drug. In case of any type of acute glomerulonephritis it is necessary to assess the functional state of liver and after the treatment of the main disease hepatologist follow-up of patients is recommended. Thus in the development of acute reno-cardial syndrome (ARCS) the degree of manifestation of hypervolemia with hypertension, as a result of active immune inflammation of the glomerular apparatus with the development of AKI, plays the main role in the development of ARCS with APSG.. As a rule ARCS in case of APSG with ANS in young adults has a successful outcome.

Clinical Characteristics of Acute Coronary Syndrome in Young Patients

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide [6]. They account for 31.5 percent of all deaths on the planet and 45 percent of deaths from non-communicable diseases, which is twice the death rate from cancer [7]. OCD is one of the most dangerous variants of IBD because it is the main nosological unit that causes death and disability among all cardiovascular diseases. Despite the positive changes achieved in recent years, the mortality rate from diseases of the circulatory system in our country and around the world remains high [12]. With the aging of the population, OCD becomes an increasingly common phenomenon

Prevalence of Erectile Dysfunction among Type-2 Diabetes Mellitus & Availability of Treatment Options in Pakistan

Introduction Erectile dysfunction has been defined as failure to obtain and maintain an erection sufficient for sexual intercourse or decreased erectile turgidity on 75% of sexual occasions, lasting for at least six months. Estimates of the prevalence of erectile dysfunction (ED) in men with diabetes range from 20% to 85% [1]. Type 2 Diabetes patients have a high risk of sexual dysfunction in men; three times increased risk of ED was seen in diabetic compared with nondiabetic men. There are multiple risk factors which include, obesity, age-related hormonal changes metabolic syndrome in young patients, it is associated with a greater increase in the risk of future cardiac events as compared to its first detection in older males. Aim The aim of the study is to determine the relative prevalence of Erectile Dysfunction in the Pakistani population attending diabetes with help of the SHIMS score/IELTS. To establish further management of this commonly under-recognized, under-discussed, and commonly untreated complication of diabetes. But it is also one of the most treatable diabetic complications. It is a “couple’s disorder,” affecting both the patient and his partner. In Pakistan, there is not much evidence & options for treatment are not ideally available inclusive of the availability of PD5 drugs. Methodology Male patients with diabetes mellitus having poor glycemic control, hypertension, and hyperlipidemia with or without active complaint of Erectile Dysfunction attending The Diabetes Centre (TDC) during the study period were enrolled in the study. 319 males with diabetes were examined by the Diabetologist, endocrinologist, and clinical psychologist. Patients were surveyed using the five items version of the International Index of Erectile Dysfunction questionnaire, also known as the Sexual Health Inventory of Men (SHIM) to determine the presence and severity of ED and the efficacy of ED treatment conditions. Discussion and Results In the study, a total of 319 diabetic patients were enrolled and assessed/examined. Those with severe ED were found to have poor glycemic control, abnormal lipid profile, with BMI. 19%, 15%, and 31% of patients scored as severe, moderate, and mild to moderate ED respectively; 65% were scored as suffering in ED, whereas 20% of diabetic male patients have a higher proclivity of developing server ED. Male patients with poor glycemic control & hyperlipidemia were suffering from severe erectile dysfunction. Conclusion The accumulated percentage of diabetic male patients who have signs of ED is higher therefore the prevalence of ED is too high in diabetic male patients. In addition, there are no appropriate management options like the availability of safe drugs and treatment in Pakistan.

Comparative outcomes of anticoagulation alone versus anticoagulation plus endovascular intervention in adults with isolated renal vein thrombosis

BackgroundLimited therapeutic strategies are available for adults with isolated renal vein thrombosis (RVT). In the present study, we explore and compare the efficacy of anticoagulation therapy alone vs anticoagulation plus endovascular intervention in the treatment of this rare disease. MethodsIn the present study, we analyzed the clinical data of RVT patients treated in a tertiary referral center in urban China from April 2012 to April 2022. These patients were classified into anticoagulation therapy (best medical treatment [BMT]) and endovascular intervention (endovascular-based treatment [EBT]) groups. The primary end points, including thrombus clearance and renal function changes, were evaluated by measuring the serum creatinine levels and glomerular filtration rates (GFRs). ResultsA total of 40 consecutive patients with RVT (25 men and 15 women) were included in the present study, with a median age of 37 years (range, 18-72 years). Some patients developed symptoms, including 12 with low back pain (30%), 11 with lower extremity edema (28%), and 10 with abdominal pain (30%). Nephrotic syndrome was the underlying etiology for most patients (30 of 40; 75%). Additionally, 28 patients (70%) developed unilateral RVT, including 18 cases of left RVT (45%). Of the 40 patients, 17 had received BMT (42%) and 23 had received EBT (58%). In the acute phase of RVT, defined as <14 days from symptom onset, the EBT group had higher thrombus clearance and better improvement of creatinine and GFR after treatment compared with the BMT group (P < .05). In the subacute phase, defined as 14 to 30 days after symptom onset, thrombus clearance was higher in the EBT group than in the BMT group (P < .05). However, the improvement in creatinine and GFR were insignificantly different between the two groups (P > .05). ConclusionsThe etiologies of RVT can and should be investigated. In the present study, RVT was primarily caused by nephrotic syndrome in young patients and also was attributed to malignancy and lupus nephritis. In addition to anticoagulation therapy, endovascular intervention, including catheter-directed thrombolysis and mechanical thrombectomy, contributed to the improvement of renal function in patients with acute RVT. Endovascular intervention markedly promoted thrombus clearance in patients in the subacute phase but did not improve renal function. Therefore, endovascular intervention should be considered if RVT is diagnosed in the acute phase.

To Study the Profile of Metabolic Syndrome in Young Patients of Acute Coronary Syndrome

To Study the Profile of Metabolic Syndrome in Young Patients of Acute Coronary Syndrome

Clinical and Angiographic Profile of Acute Coronary Syndrome in Young Patients

Clinical and Angiographic Profile of Acute Coronary Syndrome in Young Patients

ODP418 Late-Onset Hypogonadism Detected in Young Male Patients Suffering From Post COVID-19 Condition

Abstract At least one-third of post COVID-19 patients suffer from various chronic symptoms, defined by WHO as "post COVID-19 condition". However, the pathogenesis of post COVID-19 condition and its clinical course remain unclear. In February 2021, we set up an outpatient clinic specialized for COVID-19 after care (CAC) in Okayama University Hospital in Japan and we have investigated the clinical characteristics of patients with post COVID-19 condition. Our recent study revealed that general fatigue is the most common symptom in the post COVID-19 condition. Direct effects of viruses on each organ and conditions such as post-intensive care syndrome, post-traumatic stress disorder, and myalgic encephalomyelitis / chronic fatigue syndrome have been considered as possible etiologies. Recently, it has been suggested that endocrine disruption including the hypothalamic damage might be involved in the underlying mechanism. In the present study, we focused on male hypogonadism, called late-onset hypogonadism (LOH) syndrome. LOH syndrome causes fatigue and metabolic syndrome in middle-aged males. The aim of this study was to clarify the clinical characteristics of patients with LOH syndrome who visited our CAC outpatient clinic. We retrospectively reviewed medical records of all 39 male patients in whom serum free testosterone (FT) level was measured between February 2021 and November 2021 in our CAC outpatient clinic. As a result, 19 patients (48.7%) met the criteria for LOH syndrome (FT &amp;lt; 8.5 pg/mL; LOH group), and 14 (73.6%) of those patients were under the age of 50 years. A weak negative correlation was found between age and serum FT level (R=-0.301, p=0. 0624). A comparison of the LOH group with the non-LOH group showed that there were no significant differences in the patients’ background factors including age (36. 0 vs. 37.5 years), acute hospitalization (9 patients, 47.4% vs. 5 patients, 25. 0%), and number of days between COVID-19 onset and CAC outpatient clinic visitation (71 vs. 81 days). There were also no significant differences in various laboratory parameters between the two groups. However, symptoms including anxiety, cough and hair loss were more frequent in the LOH group. Compared to the incidence of LOH syndrome in the general population, the present study revealed that there is a relatively high incidence of LOH syndrome in young patients with post COVID-19 condition. Although it is known that gonadal functions are impaired in the acute phase of COVID-19, hypogonadism is also thought to be related to the chronic phase of COVID-19. Leydig cells in the testis may be susceptible to damage by SARS-CoV-2 virus because of the high level of ACE2 receptor expression; however, the underlying mechanisms of LOH syndrome due to post COVID-19 condition have yet to be elucidated. Presentation: No date and time listed

Characteristics and prognosis of the catecholamine induced QT prolongation syndrome

Abstract Background We have recently demonstrated association of unexplained sudden cardiac arrest (SCA) with inheritance of catecholamine induced QT prolongation (CIQTP). Objective We here aim to describe incidence, characteristics and prognosis of this new syndrome in young patients with unexplained SCA or their relatives. Methods We reviewed the medical screening of all consecutive patients or their first-degree relatives explore from 2015 after the occurrence of a SCA before age 45. Structural heart disease or inherited arrhythmia diseases were excluded. A mental stress test was performed, as previously described, for each family members. All families with a positive mental stress were included in the study. Genetic screening was performed in at least one positive patient per family using targeted sequencing on a panel of 109 genes associated with inherited arrhythmias and cardiomyopathies. Results Among 456 patients screened (24 after SCA, 432 for familial screening) of 153 families, we identified 10 families (6.5%) with a catecholamine induced QT prolongation. No mutation was identified in these families. One hundred and ten patients were screened in CIQTP families. Thirty-four patients (30.9%) presented a CIQTP (mean age 42±20 yo, 64.7% of women). Five (14.7%) patients presented with previous symptoms (including 4 syncope and 1 SCA). Two patients (5.9%) were implanted with an ICD and eleven (32.3%) were treated with beta blocker therapy mainly because of QT prolongation &amp;gt;500 ms after mental stress test or previous symptoms. After a 3.6±1.8 years of follow up, no sudden cardiac death nor syncope occurred on beta blocker therapy except for one patient implanted with an ICD after a SCA. Under beta blocker treatment the patient was asymptomatic for 5 years. After a suddenly stop of the beta blocker treatment, the patient underwent VF. For 3 years now the patient is asymptomatic under beta blocker treatment. Conclusions In our experience, CIQTP families represent 6.5% of cases of unexplained SCD and suggest systematic screening with a mental stress test for family screening after the occurrence of a SCA. Beta blocker therapy is very efficient to reduce the risk of SCA. Funding Acknowledgement Type of funding sources: None.

Outcome of post-traumatic acute respiratory distress syndrome in young patients requiring extracorporeal membrane oxygenation (ECMO)

We aimed to evaluate the outcomes of post-traumatic acute respiratory distress syndrome (ARDS) in young patients with and without Extracorporeal membrane oxygenation (ECMO) support. A retrospective analysis was conducted for trauma patients who developed ARDS at a level I trauma facility between 2014 and 2020. Data were analyzed and compared between ECMO and non-ECMO group. We identified 85 patients with ARDS (22 patients had ECMO support and 63 matched patients managed by the conventional mechanical ventilation; 1:3 matching ratio). The two groups were comparable for age, sex, injury severity score, abbreviated injury score, shock index, SOFA score, and head injury. Kaplan Meier survival analysis showed that the survival in the ECMO group was initially close to that of the non-ECMO, however, during follow-up, the survival rate was better in the ECMO group, but did not reach statistical significance (Log-rank, p = 0.43 and Tarone-Ware, p = 0.37). Multivariable logistic regression analysis showed that acute kidney injury (AKI) (Odds ratio 13.03; 95% CI 3.17–53.54) and brain edema (Odds ratio 4.80; 95% CI 1.10–21.03) were independent predictors of mortality. Sub-analysis showed that in patients with severe Murray Lung Injury (MLI) scores, non-ECMO group had higher mortality than the ECMO group (100% vs 36.8%, p = 0.004). Although ARDS is uncommon in young trauma patients, it has a high mortality. ECMO therapy was used in a quarter of ARDS cases. AKI and brain edema were the predictors of mortality among ARDS patients. ECMO use did not worsen the outcome in trauma patients; however, the survival was better in those who had severe MLI and ECMO support. Further prospective study is needed to define the appropriate selection criteria for the use of ECMO to optimize the outcomes in trauma patients.

Acute coronary syndromes in young patients and thrombophilia : the experience of our hospital

Abstract Funding Acknowledgements Type of funding sources: None. Background The number of young patients presenting with acute coronary syndromes is increasing. Among them, there is a large number of patients without major cardiovascular risk factors raising concerns about the cause of the acute coronary syndrome. It is known that thrombophilia is an independent risk factor for myocardial infarction. Purpose To evaluate the frequency of thrombophilia in young patients presenting with acute coronary syndrome. Methods We performed genetic testing for the most frequent gene mutations responsible for thrombophilia (factor V Leiden, PAI I 4G/5G, prothrombin G20210A, MTHFR C677T, MTHFR A1257C, MTHFR A1298C) in all patients presenting with acute coronary syndrome that were aged &amp;lt;40 (men) or &amp;lt;45 (women), for a period of 10 years. Results We recorded 127 patients , 114 (89.76%) male and 13 (10.23%) female. Their mean age was 36±1.7years.Regarding the conventional cardiovascular risk factors, 67/127(52.75%) were smokers, diabetes mellitus was present in 26/127(20.47%), arterial hypertension in 12/127(15.24%), positive family history in 92/127(72.44%) and dyslipidemia in 79/127(62.2%).The genetic testing was positive for thrombophilia in 109/127 (85.82%). 25/109 (22.93%) were factor V Leiden homozygotes, 11/109 (10.09%) factor V Leiden heterozygotes, 17/109(15.59%), PAI I 4G/5G homozygotes, 8/109 (7.33%) PAI I 4G/5G heterozygotes, 36/109 (39.24%) G20210A homozygotes and 12/109 (13.08%) G20210A heterozygotes. Conclusion Thrombophilia seems to be present in the majority of young patients presenting with acute coronary syndrome and should not be overlooked. More studies are needed t identify whether the presence of thrombophilia affects the prognosis of these patients as well as whether is necessary a different approach in their treatment and management.

Prevalence of Metabolic Syndrome in Young Patients with Acute ST Elevation Myocardial Infarction (STEMI)

Background: The metabolic syndrome is linked to several conventional and rising pro-thrombotic and pro-inflammatory cardiac risks. Most patients with cardiovascular disease have metabolic syndrome; however, the occurrence and connection of its various elements aren't obvious. There isn't any research regarding the occurrence of Metabolic Syndrome in young patients with acute STEMI. Objective: The purpose of this study was to figure out the occurrence of metabolic syndrome (MS) in young patients shown ST-Elevation Myocardial Infarction (STEMI) at a tertiary care hospital in Karachi, Pakistan. Material and Methods: The research was conducted on 170 patients with STEMI. Body mass index was measured. Smoking level, metabolic syndrome (MS), and aspects of the metabolic syndrome (BMI &gt;23 kg meter per square, high blood pressure, hypertriglyceridemia, low-plasma HDLc, and affected fasting plasma glucose) were noted. Descriptive statistics were used, and stratification was done in the study. Fisher exact test and post-stratification by square test were used during the research study. P-value ≤0.05 was regarded as significant. Results: There were 42.2% women and 57.6% men with a mean age of 29.84±7.96 years. Metabolic syndrome (MS) was positive in 64.7 per cent of sufferers. BMI &gt;23 kg meter per square was noticed in 97.1 per cent of patients. High blood pressure in 72.4 per cent of patients. Hypertriglyceridemia in 77.65 per cent of patients, Low plasma HDLc in 44.1 per cent of individuals, and affected fasting plasma glucose in 47.1 per cent of patients. Conclusion: It had been determined by research findings that the occurrence of metabolic syndrome in young patients having STEMI was higher. The common element was BMI &gt;23 kg/m2, Hypertension, and Hypertriglyceridemia. Keywords: Prevalence, Young Patients, Metabolic Syndrome (MS), STEMI, Aspects of MS

Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome as Risk Factors for Acute Coronary Syndrome in Young Patients: Analysis of the National Inpatient Sample.

This study aimed to compare the odds of acute coronary syndrome (ACS) in patients aged 18 to 40 years to patients older than 40 years with and without secondary diagnoses of systemic lupus erythematosus (SLE) or antiphospholipid antibody syndrome (APLS) while controlling for traditional cardiovascular (CV) risk factors. Data were extracted from the National Inpatient Sample database from 2016 to 2018. The National Inpatient Sample was searched for hospitalizations of adult patients with ACS as the principal diagnosis, with and without SLE or APLS as secondary diagnoses. Age was divided categorically into 2 groups: adults aged 18 to 40 years and those older than 40 years. The primary outcome was the development of ACS. Multivariate logistic regression analyses were used to adjust for confounders. There were 90,879,561 hospital discharges in the 2016 to 2018 database. Of those, 55,050 between the ages of 18 to 40 years and 1,966,234 aged older than 40 years were hospitalized with a principal diagnosis of ACS. Traditional CV risk factors were associated with ACS hospitalizations in both age groups. In multivariate analysis of the 18 to 40 years age group, both SLE (odds ratio, 2.18; 95% confidence interval, 1.814-2.625) and APLS (odds ratio, 2.18; 95% confidence interval, 1.546-3.087) were strongly associated with ACS hospitalizations. After the age of 40 years, there were no increased odds of ACS hospitalizations for SLE or APLS. In the younger population, SLE and APLS were strongly associated with ACS hospitalizations in addition to the traditional CV risk factors. In the older age group, traditional CV risk factors dominated and diluted the effect of SLE and APLS.

Workup for Suspected Brugada Syndrome: Two Case Reports for the General Practitioner

While a large proportion of ST-segment elevation on EKG is related to myocardial ischemia, the differential diagnosis must include pericarditis, channelopathies, and various genetic conditions. Identifying and working up such abnormalities present a challenge to primary care providers (PCPs). We present two clinical cases of young male patients with ST-segment elevation in anteroseptal leads suspicious for Brugada syndrome and show how to risk stratify and manage them.Our first case presents a 23-year-old male with no past medical history with acute onset substernal chest pain, shortness of breath, and palpitations. Initial workup revealed negative serial troponins and normal B-type natriuretic peptide (BNP). The EKG revealed ST elevation in lead V2. An evaluation for Brugada syndrome was pursued. Upon completion of a procainamide challenge, it was determined that he did not have Brugada syndrome and was shortly discharged.Our second case presents a 33-year-old male with no pertinent cardiac medical history who presented to an outpatient cardiology clinic after discovering an incidental ST elevation in V2 on EKG. His family history was negative for early atherosclerotic cardiovascular events or sudden cardiac death. The patient’s initial workup was negative. Suspicion for Brugada syndrome leads to performing a procainamide challenge, which was significant for ST changes in the anterolateral leads. He was asymptomatic during the challenge and initial presentation, and no further intervention was indicated. He was advised to avoid sodium channel blocking medications and treat any fevers and was sent for genetic testing.These cases illustrate the importance of maintaining an appropriate suspicion for Brugada syndrome in young patients with minimal ischemic risk factors. We discuss a guideline-directed algorithmic workup for PCPs in suspicious individuals. Stratifying patients based on the presence of symptoms, history of tachyarrhythmias, and EKG findings before and after drug challenge allows physicians to guide further management of these patients.

Acute coronary syndromes in young patients: Phenotypes, causes and clinical outcomes following percutaneous coronary interventions.

BackgroundThe prevalence of acute coronary syndromes (ACS) among young individuals is increasing, but the phenotypic characteristics, causes and clinical outcomes in this group have not been well described. MethodsBetween 2009 and 2017, 8712 ACS patients underwent percutaneous coronary intervention (PCI) and were prospectively enrolled. We defined a young patient as female <50 years and male <45 years. The causes of ACS were defined by an adjudication committee. The primary endpoint was the patient-oriented composite endpoint (POCE) of all-cause mortality, myocardial infarction or any revascularization at 12 months. ResultsAmong 8712 ACS patients, 472 (5.4%) patients were young (26% female). The main cause of ACS in young patients was atherosclerosis (86.5%), followed by coronary artery embolism (9%), and spontaneous coronary artery dissection (SCAD) (4.5%). POCE occurred less frequently in young compared to old patients (8.5% vs. 16.7%, hazard ratio 0.48 (95% confidence interval 0.35–0.66), p < 0.001). The rates of the individual components of the POCE were lower in young including all-cause mortality (3.2% versus 9.5%, 0.32 (0.19–0.54), p < 0.001), myocardial infarction (1.9% versus 3.7%, 0.49 (0.25–0.95), p = 0.035) and any revascularization (5.1% versus 7.4%, 0.65 (0.43–0.97), p = 0.037). Young patients with SCAD had a higher rate of death as compared to those with atherosclerosis, mainly attributed to cardiac deaths. ConclusionsOne out of 20 ACS patients undergoing PCI was young and the principal cause was atherosclerosis. Young carry a lower risk for future events compared to older ACS patients. The underlying cause leading to ACS should be considered in appropriate risk stratification of young patients.Clinical Trial Registration:Clinicaltrials.gov. NCT02241291

Low high density lipoprotein cholesterol levels and acute coronary syndrome in young patients admitted at a tertiary care facility.

Coronary artery disease (CAD) is a cardiovascular disease which is related to mortality and morbidity among the Indians predominantly in the older age group. But, recently CAD has been found more often in young population. Hence, our study aims to observe the outcomes based on various categories of high density lipoprotein (HDL) cholesterol levels estimated during admission at the hospital and correlate the levels of HDL cholesterol with severity of CAD as measured by Gensini score. A cross-sectional study was conducted in 151 young patients (18-45 years) who were admitted at the hospital with newly diagnosed acute coronary syndrome (ACS). Tests such as electrocardiogram, cardiac enzyme assay, hematologic and biochemical tests including fasting lipid profile levels were taken into account. There was an inverse relation observed between the number of vessels involvedand HDL cholesterol levels. Those with lower levels of HDL cholesterol were more vulnerable to multi-vessel CAD. However, no association was observed between HDL cholesterol and severity of CAD as measured by Gensini score. In young patients with acute coronary syndrome and diminished HDL cholesterol levels had a greater number of vessels involved when compared with elevated HDL cholesterol levels group. However, low HDL cholesterol levels had no association with severity of CAD as measured by Gensini score. No statistically significant association was noticed between levels of HDL cholesterol and in hospital mortality /morbidity.