Typical Chest Pain Research Articles

Predicting severe multivessel coronary artery disease to guide access strategy in patients undergoing invasive coronary angiography.

Given radial artery conduits are increasingly utilized for coronary artery bypass grafting (CABG), avoiding transradial access (TRA) for invasive coronary angiography (ICA) may benefit patients who ultimately undergo CABG. We sought to predict the likelihood of severe multivessel disease (MVD) before ICA to guide this decision. This was a single-center study of 1485 patients with stable symptoms who underwent ICA. A model to predict severe MVD was developed. Relative importance analyses were performed to identify clinical characteristics most associated with the presence or absence of severe MVD. When predicting severe MVD, the model had a sensitivity of 70.3% and specificity of 71.8% (area under the curve = 0.7105). With a prevalence of 12.5% in our cohort, the model had a strong negative predictive value of 94.4%. Relative importance analyses showed factors most associated with the presence of severe MVD were a history of abnormal noninvasive tests, typical chest pain, aspirin use, insulin-dependent diabetes, increasing age, and a family history of coronary artery disease. Conversely, the absence of severe MVD was most associated with female sex, undergoing ICA as workup for either noncardiac or valve surgery, lung disease, atypical chest pain, and increased BMI. Clinical information available before ICA can risk stratify the likelihood of severe MVD and therefore aid in identifying patients that may need CABG and could stand to benefit from TRA avoidance. The potential benefits of maximizing radial artery conduit availability by avoiding TRA must be balanced against the risks of alternative access on an individual patient basis.

An Unusual Cause of Typical Chest Pain

An Unusual Cause of Typical Chest Pain

Abstract 4135212: An Overlap Between Takotsubo Cardiomyopathy and Hypertrophic Obstructive Cardiomyopathy Causing Dynamic Left Ventricular Outflow Tract Obstruction: A Unique Case Report

Background: Takotsubo cardiomyopathy (TC) can cause dynamic left ventricular outflow tract (LVOT) obstruction leading to cardiogenic shock. Due to differential wall-motion abnormalities, flow acceleration in the LVOT can lead to systolic anterior motion (SAM) of the mitral valve which worsens LVOT obstruction and leads to hemodynamic compromise. We present a case of overlap between TC and hypertrophic obstructive cardiomyopathy (HOCM) with worsening LVOT obstruction leading to cardiogenic shock. Case: A 76-year-old female presented with typical chest pain, nausea, and worsening shortness of breath. On examination, she was hypotensive and cold to touch. EKG showed T-wave inversions in lateral leads with elevated cardiac troponins. Coronary angiogram showed non-obstructive coronary artery disease, and right heart catheterization revealed elevated filling pressures. Transthoracic echocardiogram (TTE) showed septal hypertrophy and SAM of the mitral valve causing dynamic LVOT obstruction (Figure 1) and ejection fraction (EF) of 20%. TTE with contrast showed apical ballooning consistent with TC (Figure 2). Decision Making: Initially with diuresis, she became hypotensive so it was stopped and she received controlled intravenous fluids along with phenylephrine to reduce LVOT obstruction. Her blood pressure improved and she was started on low-dose metoprolol succinate along with ivabradine to reduce heart rate. She tolerated this therapy and hemodynamics stabilized. Conclusion: Cardiogenic shock can be a severe complication of TC. Early detection of LVOT obstruction in cardiogenic shock is important as traditional management strategies of increased inotropy and reduction of afterload can be fatal in these cases. The treatment strategy focuses on reducing the LVOT gradient and includes fluid administration to increase preload, beta-blockers to increase diastolic filling time, and vasopressors to raise afterload.

Ischemic Heart Disease; An Overview of Atypical Presentation & Misdiagnosis

Cardiovascular disease is considered to be one of the main causes of death worldwide. The most common cardiovascular disease is ischemic heart disease (IHD). The cause of IHD is coronary blood flow reduction therefore also known as “coronary heart disease”. Incidence of IHD has been increase worldwide. IHD symptoms and sign range from typical classic chest pain to atypical e.g., epigastric discomfort and seizure. Patients present with atypical picture been misdiagnosed, this lead in delay of providing the appropriate care and treatment which will lead to worse outcomes and even death. In this review we are aiming to study the different clinical pictures of IHD mainly atypical presentation so patient can be treated earlier. Also, we are studying risk factors associated with IHD so can be managed as long as possible.

NICE guidance in the rapid access chest pain clinic: does it work?

Abstract Background Rapid Access Chest Pain Clinics (RACPC) were developed following the publication of the National Service Framework for Coronary Heart Disease in 2000(1). The National Institute for Health and Care Excellence (NICE) produces guidelines for the management of patients with recent onset chest pain of suspected cardiac origin(2). In 2016 the guidance was updated and recommended the use of CT coronary angiography (CTCA) as the initial investigation for patients with chest pain which was typical or atypical of angina. Adherence to the guideline may be dependent upon factors such as local availability of CT scanners and clinician preference. The RACPC in this tertiary centre is nurse-run with no medical involvement. There is good engagement with the CT department and in July 2017 the NICE guidance was adopted in the clinic. Purpose To evaluate the use of CTCA as the first line investigation for patients with typical or atypical chest pain. Methods Data from all patients reviewed in the clinic between 01/07/2017 and 31/12/2023 were prospectively collected, entered into a database, and then retrospectively analysed. The data were organised into 3 groups: patients with typical chest pain; atypical pain and those with non-cardiac sounding chest pain. The number of patients in each group who underwent a CTCA, and the outcome of the scan were evaluated. The CT scans were categorised as showing significant coronary artery disease (CAD), non-obstructive CAD, no CAD, or as inconclusive. The outcome of patients who had a positive CTCA was also recorded. Results 2986 patients were reviewed in the RACPC in the above period. 14.2% of patients presented with typical pain, 47.4% with atypical pain, and 30.6% had non-cardiac pain. The remaining patients presented with other symptoms such as breathlessness. CTCA was used as the first investigation in the majority of patients with typical or atypical pain, unless alternative investigations or management were deemed to be more clinically appropriate. In 59.5% of typical and 78.5% of atypical presentations, the CT scan showed no CAD, or non-significant CAD. There was a low incidence of positive scans in both groups, however patients with typical pain were more likely to have significant CAD (Table). All patients who had a CTCA indicating significant CAD, were referred for invasive angiography. 88.0% of typical presentations, and 64.0% of those with atypical pain, underwent revascularisation. No patient who underwent invasive angiography was found to have normal coronary arteries. Conclusion Atypical pain is the most frequent presentation in the RACPC, however the majority of these patients, and most of those with typical pain, do not have significant CAD. Careful assessment and the use of CTCA as the initial investigation, enable the identification of those patients who need invasive angiography. This is a cost-effective strategy which also reduces risk and radiation exposure for patients.

Comparison of clinical symptoms and prognosis of non-post-menopausal women to age matched men admitted with ST-elevation myocardial infarctions

Abstract Background Although ST-elevation-myocardial infarctions (STEMI) in women before menopause are relatively uncommon, previous studies have shown that women in general are more likely to present with atypical symptoms and to show higher adverse event rates, which might at least be attributable to the on average higher age of women during the index event. Aim of the present study was therefore to compare in an age-matched cohort of STEMI-patients younger 55 years the likelihood of atypical symptoms between genders and to investigate the impact of female gender on short and long-term-outcome. Methods Patients <55 years of age with STEMI admitted between 2006 and 2022 to a German heart center were included in the analysis and women were compared to men with regard to clinical symptoms and outcome. To exclude local bias women of all ages with STEMI from the registry were compared to men in a control group. Results Of 12094 STEMI-patients in the total cohort 3343 (28%) were women and 8751 (72%) were men. Women had a mean age of 69.7±13 yrs. compared to 62.2±12 in men. Women with STEMI had a 40% higher chance to present without typical chest pain (no CP, 12.0% vs. 8.5%, p<0.01) and were more likely to present with dyspnea (26.1% vs. 22.7% p<0.01). While rates of late STEMI-presenters were numerically higher in women, this difference failed to reach significance (12.8% vs. 11.9%, p=0.16). When focusing however on the study group (<55 yrs. of age) there was no more age difference (women 47.2±6 yrs. vs. 47.5±6 yrs. in men, p<0.3) and rates of no CP were not different between genders: 5.7%(women) vs. 5.4% (men), p=0.79, nor were rates of dyspnea : 20.0% (women) vs. 18.5% (men), p=0.45. There was even a trend towards lower rates of late STEMI-presenters in women: 8.3% vs. 10.9% in men, p=0.077, although diabetes-rates were higher in women (16.9% vs. 11.8%, p<0.01). Despite similar initial symptom presentations, women showed a marked 60% increase in 30-day- (6.9% vs. 4.3%, p=0.017) and 1-year-mortality (8.7% vs. 5.3%, p<0.01). The disadvantage for women remained, when adjusting mortality rates for confounders (age, diabetes, anterior STEMI, multivessel disease, PCI result) in a Cox regression model (table, upper part). This could be confirmed in a subgroup multivariate analysis excluding patients with no CP or not undergoing emergency PCI (table, lower part). Conclusions In STEMI-patients younger 55 years women showed a more than 60% higher short- and long-term-mortality compared to their male peers. This disadvantage, at least with our data, cannot be sufficiently explained by higher rates of delayed STEMI-presentations or absence of typical chest pain. Further studies are needed to identify possible causes for this higher vulnerability of young women to acute myocardial infarctions.Table:Mortality in Women vs. men<55 yrs

Multi-modality deep learning model for prediction of chronic obstructive coronary artery disease

Abstract Background/Introduction The incidence of coronary artery disease (CAD) is on the rise with an increasing burden of stable ischemic heart disease (SIHD) and high prevalence of obesity, diabetes, hyperlipidemia, and other cardiovascular risk factors. Pre-test probability estimation for CAD based on demographic features and characterization of chest pain is insufficient to accurately assess whether further evaluation for CAD is warranted. Purpose To develop and validate a deep learning (DL) algorithm utilizing electrocardiogram (ECG) waveforms and clinical features to predict obstructive CAD. Methods Clinical data from subjects undergoing invasive angiography over a 4-year period at a quaternary care center exclusive of subjects who had concern for acute coronary syndromes were used for model training. ECGs obtained up to 5 years prior to angiography were included; ECGs were partitioned 8:1:1 for training, validation, and test datasets. Obstructive CAD was defined as receiving percutaneous coronary intervention during elective angiography. Convolutional neural network models were developed for ECG waveforms alone (DL-ECG), clinical features from standard risk scores (DL-Clinical), and the combination of ECG waveforms and clinical features (DL-ECG+Clinical); a commonly used pre-test probability estimation tool derived from the CAD Consortium study was used as a comparison (PTP). The models were evaluated based on area under the curve receiver operating characteristics (AUC). Shapley additive explanations (SHAP) analysis was performed to understand feature importance in the DL models. Results A total of 40,602 ECGs and 8,361 coronary angiograms from 7,201 patients were included in the analysis. The median age was 66 (IQR 56-75), 71.9% were men, 34.9% had hypertension, 30.6% had diabetes mellitus, and 39.0% had dyslipidemia. The PTP model (AUC 0.733 [0.717-0.750]) had similar performance as the DL-Clinical model (AUC 0.762 [0.746-0.778]). The DL-ECG model (AUC 0.741 [0.726-0.758]) had similar performance as both the clinical feature models. The DL-ECG+Clinical model (AUC 0.807 [0.793-0.822]) trained on ECG waveforms and clinical features had a superior performance (Figure 1). SHAP analysis for the DL-ECG+Clinical model revealed that ECG waveforms had the largest influence on the model’s output followed by age and chest pain type (Figure 2). Conclusions Multi-modality DL model utilizing ECG and commonly used features can improve prediction of obstructive CAD in SIHD compared to traditional pre-test probability estimates. Prospective research is warranted to determine whether incorporation of DL methods to ECG analysis effectively improves diagnosis and outcomes in obstructive CAD.Figure 1.Figure 2.

Heart disease prediction using machine learning models

Abstract. Heart disease remains a global health threat, making rapid identification crucial. Using the Heart Disease Dataset from Kaggle, this research employs a Random Forest model to analyze 13 clinical variables from 1,025 samples. To improve accuracy and address class imbalance, the dataset was split into training and test sets, utilizing methods such as Z-scores, SMOTE, and feature selection. The Random Forest model, which combines multiple decision trees, achieved high performance with an accuracy of 98.54%, identifying key predictors such as chest pain type, maximum heart rate, and thalassemia. Compared to a single decision tree, the Random Forest model reduces overfitting, improves generalization, and increases predictive accuracy. Factors like cholesterol levels, resting blood pressure, and exercise-induced angina were also considered. By averaging results from multiple trees, the model offers reliable and stable predictions, highlighting its potential in clinical settings for early detection and personalized treatment strategies. This study aims to assist healthcare providers in better allocating resources, planning preventive measures, and tailoring treatment plans to individual patients.

Young Women and Myocardial Infarction: Unveiling Clinical Patterns and Prognostic Outcomes.

Background Myocardial infarction (MI) remains a critical emergency with an increasing incidence among young women exposed to various risk factors. Despite extensive data on MI, there is limited information on premature coronary artery disease in women under the age of 50 years. This study describes the clinical, paraclinical, and angiographic characteristics of MI in young women compared to older women and determines the prognosis. Methods This is a single-center retrospective study including womenhospitalized between July 2019 and December 2021 in the cardiology departmentfor the evaluation of MI. The population was divided into two groups based on age: women under 50 years, classified as youngwomen, and those aged 50years and above. A comparison was made between these two groups. Results A total of 197 women were included in our study. Forty-four women under 50 and 153 over 50 years were included. The mean age of young women was 44 ± 6 years. The main cardiovascular (CV) risk factors in young women were smoking (46%), hypertension (53%), diabetes (44%), and family history of coronary artery disease (21%). Autoimmune disease was present in 11%. Of the young women,34% were admitted for ST-elevation myocardial infarction (STEMI), with 47% consulting late (>12 hours). The majority (91%) presented with typical chest pain. Monovessel disease was observed in 57% of young women. The left anterior descending artery was the most affected at 55%. Atherosclerosis was the most noted etiology (66%), followed by spontaneous coronary artery dissection (SCAD) (16%). The comparative study showed that young women had fewer overall CV risk factors but a higher prevalence of smoking, familial history of coronary artery disease, and autoimmune disease. Young women presented more frequently with non-ST elevation myocardial infarction (NSTEMI). Monovessel disease was more common, and they required less myocardial revascularization by percutaneous intervention. Young women presented more with SCAD and less with atherosclerotic MI. The in-hospital follow-up showed that young women experienced fewer major cardiac and cerebrovascular events (MACCE) compared to older women, with no in-hospital deaths recorded among young women. Long-term follow-up revealed a lower incidence of MACCE among young women (11% vs. 32.7% in older women) and a similar low mortality rate. Survival analysis showed that young women had a longer event-free survival time for MACCE (91.3 months) compared to older women (65.5 months). Conclusions The incidence of MI in young women is increasing. Smoking and hypertension are major risk factors. Hospital complications are rare, and prognosis is generally good, with low mortality rates.

Implementasi K-Means Clustering pada Pengelompokan Pasien Penyakit Jantung

Heart disease is a prominent global health concern, necessitating early identification and patient grouping for effective management. This study employs the K-Means clustering algorithm with a medical dataset of 303 patients, encompassing various attributes. These include Age, Gender, Chest Pain Type, Blood Pressure, Serum Cholesterol Level, Fasting Blood Sugar, Resting Electrocardiographic Results, Maximum Heart Rate, Angina, ST Depression, and Slope of the ST Segment. The goal is to categorize patients into four clusters based on chest pain types, a crucial symptom indicating disease severity. The computation concludes after the sixth iteration, revealing Cluster 1 (27 patients), Cluster 2 (135 patients), Cluster 3 (15 patients), and Cluster 4 (126 patients). Collaborative analysis with medical experts highlights that Cluster 1, mainly comprising older males, exhibits high-risk indicators. While this grouping aids in personalized treatment strategy development, further clinical validation involving more experts and datasets is imperative for enhanced reliability.

Characteristics of Young Women Presenting With Acute Myocardial Infarction: The Prospective, Multicenter, Observational Young Women Presenting Acute Myocardial Infarction in France Study.

The percentage of women <50 years of age hospitalized with myocardial infarction is increasing. We describe the clinical, morphological, and biological characteristics, as well as the clinical outcomes of this population. This prospective, observational study included consecutive women <50 years of age admitted for myocardial infarction at 30 centers in France (May 2017-June 2019). The primary outcome was the composite of net adverse clinical events: all-cause death, cardiovascular death, recurrent myocardial infarction, stent thrombosis, any stroke, or major bleeding occurring during hospitalization with a 12-month follow up. Three hundred fourteen women were included. The mean age was 43.0 (±5.7) years, 60.8% presented with ST-segment-elevation myocardial infarction, 75.5% were current smokers, 31.2% had a history of complicated pregnancy, and 55.1% reported recent emotional stress. Most (91.6%) women presented with typical chest pain. Of patients on an estrogen-containing contraceptive, 86.0% had at least 1 contraindication. Of patients with ST-segment-elevation myocardial infarction, 17.8% had myocardial infarction with nonobstructive coronary arteries and 14.6% had spontaneous coronary artery dissection, whereas 29.3% presented with multivessel vessel disease. During hospitalization, 11 net adverse clinical events occurred in 9 (2.8%) women, but no deaths or stent thromboses occurred. By 12 months, 14 net adverse clinical events occurred in 10 (3.2%) women; 2 (0.6%) died (from progressive cancer) and 25 (7.9%) had an ischemia-driven repeat percutaneous coronary intervention. Most young women with myocardial infarction reported typical chest pain and had modifiable cardiovascular risk factors. History of adverse pregnancy outcomes and prescription of combined oral contraceptive despite a contraindication were prevalent, emphasizing the need for comprehensive cardiological and gynecological evaluation and follow-up. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03073447.

Frequency of non-st segment elevation myocardial infarction (NSTEMI) in acute coronary syndrome among patients presenting with the chest pain in emergency department of tertiary care hospital.

Objective: To determine the frequency of NSTEMI (non- st elevation myocardial infarction) in acute coronary syndrome patients presenting with the chest pain in emergency department of tertiary care hospital. Study Design: Cross Sectional study. Setting: Jinnah Post graduate Medical College Hospital Karachi. Period: June 20, 2023. Methods: Enrolling 112 consecutive volunteers was carried out Interview questions focused on the participants' smoking, blood pressure, diabetes, and type of chest pain. Whether or not the participants had ACS, their diagnosis was documented. NSTEMI frequency was computed. Results: We have 112 patients enrolled with mean age was 52.73±14.24 years. Sixty five (58%) were male while forty seven (41.9 %) were females. out of 112 patients 45 (40.1%) were hypertensive, 32(28.5%) were diabetes and 29 (25.8%) were smoker. Among the participants 21 (18.7%) had NSTEMI and showed positive correlation with age, gender, nature of chest pain, hypertension and smoking. Conclusion: Among the individuals, one of the most frequent causes of chest pain was acute coronary syndrome. High suspicion and additional testing are they key tools for early diagnosis and management.

Unveiling the Longitudinal Journey: 3-Year Follow-up of Women with MINOCA and INOCA in a Specialized Heart Centre

BackgroundMyocardial infarction with no obstructive coronary arteries (MINOCA), and ischemia with no obstructive coronary arteries (INOCA), are female-predominant conditions; clinical trials are lacking to guide medical management for the common underlying vasomotor etiologies. Data on long-term outcomes of (M)INOCA patients following attendance at a women’s heart centre (WHC) are lacking. MethodsWomen diagnosed with MINOCA (n = 51) or INOCA (n = 112) were prospectively followed for 3 years at the Leslie Diamond WHC (LDWHC) in Vancouver. Baseline characteristics, diagnoses, chest-pain type, major adverse cardiac events, hospital encounters, medications, and Seattle Angina Questionnaire (SAQ) responses were compared between the baseline and 3-year timepoints. The χ2 test was used to compare categorical variables; the Student t test was used for continuous variables. ResultsMINOCA patients had significantly more nonexertional chest pain and more diagnoses of vasospasm than did INOCA patients, who had more exertional chest pain and more diagnoses of coronary microvascular dysfunction. Following the baseline timepoint, both groups had significant reductions in cardiovascular emergency room visits, with INOCA patients also experiencing fewer cardiovascular hospitalizations. At 3 years, the most commonly prescribed medications were calcium-channel blockers, long-acting nitrates, and beta-blockers, with MINOCA patients having more acetylsalicylic acid use, and INOCA patients having more short-acting nitrate and ranolazine prescriptions. Both groups observed significant improvements in SAQ scores, with greater improvements observed in INOCA patients. Patients with depression or who were prescribed ranolazine at 3 years had worse SAQ scores at baseline. ConclusionsThe 3-year outcomes of (M)INOCA patients indicate that the LDWHC's comprehensive care model effectively improves diagnostic clarity, reduces the number of hospital encounters, optimizes medication management, and improves self-reported patient well-being.

LOGISTIC REGRESSION TECHNIQUE FOR CARDIOVASCULAR DISEASE PREDICTION

Cardiovascular diseases (CVDs) are the most common cause of death in the world. Over four out of five CVD deaths are due to heart attacks and strokes. CVD high mortality has led to about 17 million deaths worldwide. Several machine and deep learning techniques are used to classify the presence and absence of CVD. This paper presents a logistic regression (LR) technique for predicting the risk of heart diseases (HD). The goal is to create an LR algorithm and build a prediction model that would foretell the development of HD. The dataset included data on 207 patients, featuring the following: age, sex, chest pain type, blood pressure, cholesterol levels, fasting blood sugar &gt; 120 mg/dl, electrocardiogram results, maximum heart rate, exercise-induced angina, ST depression, slope of the ST segment, number of major vessels colored by fluoroscopy, and thallium scan results. Using this dataset to train the LR technique, a robust model was created to accurately predict the existence of HD in new patients. With an accuracy of 81%, a precision of 83%, and a recall score of 76%, the accuracy, precision, and recall key metrics were used to evaluate the model's efficacy. The model’s accuracy was compared to alternative methods, such as K-Nearest Neighbors and Decision Tree classifiers, which yielded accuracy of 81% and 76%, respectively. The obtained results are of great significance for healthcare providers – the proposed model can assist in identifying those who are at high risk of heart diseases and allow for early implementation of prophylactic...

Acute Inferior ST-elevation Myocardial Infarction Arising from Wrap-Around Left Anterior Descending Artery Occlusion

BACKGROUND: Acute myocardial infarction (AMI) remains a leading cause to global morbidity and mortality. Inferior MI predominantly stems from the right coronary artery (RCA) in more than 80% of instances, the left circumflex coronary artery (LCx) in fewer than 20% of cases, and infrequently from the left anterior descending artery (LAD) AIMS: This case report aims to highlight a rare occurrence of LAD occlusion initially manifested as inferior MI. CASE: A 56-year-old male presented with typical chest pain lasting for 6 hours. Vital signs were within normal range. Initial electrocardiogram (ECG) revealed ST-segment elevation in inferior leads (II, III, aVF). Laboratory tests indicated elevated troponin levels (&gt;25ng/mL). Coronary angiography identified the culprit lesion as the LAD, which wrapped around the apex. DISCUSSION: While ECG alterations are valuable in identifying thrombosed vessels during AMI, the presence of simultaneous ST elevation in both inferior and anterior leads can hinder clinicians' ability to determine the specific artery affected by the infarction. Our case, depicting a scenario where both the right and left coronary arteries are co-dominant, showed complete occlusion at the mid-distal wrap-around LAD, resulting in ST-elevation observed in both inferior and anterior leads. CONCLUSION: The existence of inferior ST-segment elevation alongside alterations in anterior leads could imply occlusion of the wrapped LAD.

Acute ST elevation myocardial infarction (STEMI) in a patient with leptospirosis; a therapeutical dilemma – A case report

A 45-year-old previously healthy farmer was seen at the Emergency Department with ischemic type chest pain. He had a history of an acute febrile illness for four days. The ECG showed an acute anterior myocardial infarction. His laboratory investigations revealed thrombocytopenia, a raised serum creatinine level and significantly raised high-sensitive cardiac Troponin I. A provisional diagnosis of acute STEMI with co-existing leptospirosis was made. The patient was managed conservatively with antibiotics, statins, and aspirin. Neither thrombolysis nor primary coronary intervention was attempted due to high risk of bleeding. Diagnosis of leptospirosis was confirmed later by markedly elevated leptospira antibodies. After recovery, he underwent coronary angiogram which revealed a totally occluded left anterior descending artery and is awaiting myocardial viability assessment with dobutamine stress echocardiography before PCI. We report this uncommon presentation of acute myocardial infarction in a patient with leptospirosis, as it causes a considerable therapeutic dilemma especially in a resource-poor setting.

Prognostic Value of QRS Complex Fragmentation in Patients with Acute Anterior STEMI undergoing Primary PCI During in-Hospital Stay

Abstract Background Primary percutaneous coronary intervention (PCI) as a type of coronary reperfusion therapy may lead to recanalization and improved myocardial reperfusion in patients with ST elevation myocardial infarction (STEMI). Aim of the Work The aim of our study is sought to investigate the prevelance of fQRS complex in ECG of patients admitted with acute anterior STEMI undergoing primary PCI and its short-term prognostic value during hospital stay. Patient and Methods In the current study, 156 consecutive patients with anterior STEMI being treated with primary PCI between July 2021 and March 2022 were enrolled. Patients were included in the study if they presented with symptoms that were identified typically as typical chest pain lasting for more than 20 min; had ST-segment elevation ≥1 mm in two contiguous electrocardiographic and had undergone primary PCI including balloon angioplasty, thrombus aspira tion and/or stent implantation. Results Our results study showed that, in patients with a diagnosis of anterior STEMI, the presence of fQRS at admission ECG is associated with the development of MACE at short-term follow-up and higher mortality. In addition, fQRS was the strongest predictor of MACE in patients with acute MI after adjustment for the risk factors of ischemic heart disease. Conclusion Prevalence of fQRS complex on admission ECG in patients with acute anterior STEMI undergoing primary PCI is common. Presence of fQRS in these patients has independently predicted prognosis regarding LVEF values, Cath lab events, MACE and mortality during hospital stay. Therefore, fQRS can be incorporated in risk stratification tools and help in management of patients with acute anterior STEMI undergoing primary PCI.

Chest pain.

Chest pain is a common symptom in the community, with underlying causes ranging from benign musculoskeletal pain to life-threatening cardiac events. It is a challenging presentation for healthcare providers, because the aetiology is not always immediately apparent. Chest pain can also cause significant anxiety for patients, leading to increased healthcare utilisation and costs. The objective of this discussion is to emphasise the importance of accurately describing the nature of chest discomfort and using appropriate terminology to facilitate an appropriate diagnostic work-up. The discussion also highlights the differences between typical and atypical chest pain and provides information about the aetiology of chest pain and management in the community. Accurately describing the nature of chest discomfort by using appropriate terminology is crucial in identifying the underlying cause of the symptom. Healthcare providers should be aware of the different terms patients might use to describe their chest discomfort and use precise and informative terms to describe the potential underlying cause of the chest pain. Atypical chest pain is often used to describe non-cardiac chest pain, but it lacks specificity. Using the terms 'cardiac,' 'possibly cardiac' or 'non-cardiac' is the preferred terminology.

Comparison of the Clinical Manifestations of Acute Coronary Syndrome Between Diabetic and Non-diabetic Patients: A Systematic Review and Meta-Analysis.

The presentation of acute coronary syndrome (ACS) in patients with type 2 diabetes mellitus (T2DM) may differ from that of non-diabetic patients, potentially leading to delayed diagnosis and treatment. This meta-analysis aimed to compare the clinical presentation of ACS between diabetic and non-diabetic patients. A systematic search of PubMed, Excerpta Medica database (EMBASE), and Web of Science databases was conducted for observational studies published from January 2010 onwards. Studies comparing ACS symptoms between diabetic and non-diabetic patients were included. The odds ratio (OR) with 95% confidence intervals (CI) was calculated using a random-effects model. Eight studies with a total of 29,503 patients (23.03% diabetic) were included. Diabetic patients were significantly less likely to present with chest pain compared to non-diabetic patients (OR: 0.43, 95% CI: 0.30 to 0.63, p<0.001). Anxiety (OR: 2.20, 95% CI: 1.17-4.14), shortness of breath (OR: 1.49, 95% CI: 1.11-2.01), and neck pain (OR: 1.62, 95% CI: 1.03-2.54) were significantly more common in diabetic patients. Sweating/cold sweat was less common in diabetics (OR: 0.60, 95% CI: 0.34-1.07), though not statistically significant. Other symptoms showed minimal differences between groups. High heterogeneity was observed across studies for most symptoms. This meta-analysis demonstrates that diabetic patients with ACS are less likely to experience typical chest pain and more likely to present with atypical symptoms such as anxiety, shortness of breath, and neck pain. These findings emphasize the need for healthcare providers to maintain high vigilance for atypical ACS presentations in diabetic patients. Tailored diagnostic approaches, modified triage protocols, and enhanced patient education are crucial to improving the timely diagnosis and treatment of ACS in this high-risk population.

Ectatic coronary arteries, a cause for myocardial infarction with non-obstructive coronary arteries

Ectatic coronary arteries are an abnormal dilation of the coronary arteries and can contribute to the development of myocardial infarction with non-obstructive coronary arteries (MINOCA). We present a case of a previously unscreened 27-year-old man who presented with ischaemic type chest pain and was found to have ectatic coronary arteries on coronary angiogram. Despite the absence of significant stenosis, the patient experienced an acute myocardial infarction. The patient was treated with dual antiplatelet therapy and statins, and subsequent assessments showed normal echocardiography findings. Coronary artery ectasia (CAE) is a relatively uncommon condition often associated with coronary artery disease (CAD) and atherosclerosis. While antiplatelet therapy is indicated in CAE patients, the use of anticoagulation remains uncertain. Further research and clinical guidelines are needed to establish standardised management approaches for patients with CAE and MINOCA.