Café coronary syndrome – case report and medicolegal implications

Café coronary syndrome is a term used to describe a sudden collapse of healthy subjects during meals in the absence of any sign of asphyxia, respiratory distress, or neurological symptoms. Risk factors are advanced age, poor dentition, alcohol intoxication, and dementia or psychiatric disorders. One of the main problems with this syndrome is that, even when witnessed, it is often confused with myocardial infarction due to the absence of asphyxia symptoms. This leads to misdiagnosis and potential delays in patients’ treatment that can eventually have fatal outcomes. As a result of that, medico-legal litigation may arise. This paper presents a typical case of fatal café coronary syndrome misdiagnosed as a myocardial infarction. The legal authority that requested the autopsy asked about the potential professional negligence of the healthcare providers who took care of the patient. We discuss the clinical and medico-legal aspects of café coronary syndrome.

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Analysis of risk factors for different subtypes of acute coronary syndrome

Journal of International Medical Research ◽

10.1177/03000605211008326 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110083

Author(s):

Lei Zhang ◽

Juledezi Hailati ◽

Xiaoyun Ma ◽

Jiangping Liu ◽

Zhiqiang Liu ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Brain Natriuretic Peptide ◽

Left Ventricular ◽

St Segment Elevation ◽

Amino Terminal ◽

Coronary Syndrome ◽

Segment Elevation Myocardial Infarction ◽

St Segment

Aims To investigate the different risk factors among different subtypes of patients with acute coronary syndrome (ACS). Methods A total of 296 patients who had ACS were retrospectively enrolled. Blood and echocardiographic indices were assessed within 24 hours after admission. Differences in risk factors and Gensini scores of coronary lesions among three groups were analyzed. Results Univariate analysis of risk factors for ACS subtypes showed that age, and levels of fasting plasma glucose, amino-terminal pro-brain natriuretic peptide, and creatine kinase isoenzyme were significantly higher in patients with non-ST-segment elevation myocardial infarction (NSTEMI) than in those with unstable angina pectoris (UAP). Logistic multivariate regression analysis showed that amino-terminal pro-brain natriuretic peptide and the left ventricular ejection fraction (LVEF) were related to ACS subtypes. The left ventricular end-diastolic diameter was an independent risk factor for UAP and ST-segment elevation myocardial infarction (STEMI) subtypes. The severity of coronary stenosis was significantly higher in NSTEMI and STEMI than in UAP. Gensini scores in the STEMI group were positively correlated with D-dimer levels (r = 0.429) and negatively correlated with the LVEF (r = −0.602). Conclusion Different subtypes of ACS have different risk factors. Our findings may have important guiding significance for ACS subtype risk assessment and clinical treatment.

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Acute Myocardial Infarction In Systemic Mastocytosis: Case Report With Literature Review Of The Role Of Inflammatory Process In Acute Coronary Syndrome

Current Cardiology Reviews ◽

10.2174/1573403x16666200331123242 ◽

2020 ◽

Vol 16 ◽

Author(s):

Ayman Battisha ◽

Khalid Sawalha ◽

Bader Madoukh ◽

Omar Sheikh ◽

Karim Doughem ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Plasma Lipids ◽

Plaque Rupture ◽

Systemic Mastocytosis ◽

Cardiac Risk ◽

Control Group ◽

Coronary Syndrome

: Systemic Mastocytosis (SM) is a disorder of excessive mast cell infiltration in multiple organ tissues. Atherosclerosis is a major risk factor for developing acute coronary syndrome [1]. In addition to lipid accumulation in the arterial wall, inflammation plays an important role in the pathogenesis of plaque rupture and activating the thrombosis cascade [2]. The Mast cells contribution to plaque destabilization has been well established in multiple animal and human studies [3]. In a recent study, SM has been proven to be associated with a higher incidence of acute coronary syndrome even with lower plasma lipids level [4]. The study showed that 20% of patients with SM had cardiovascular events compared to only 6% in the control group with adjustment to all cardiac risk factors. Here, we present a case of acute myocardial infarction in a patient with SM with limited risk factors other than age.

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Premature Myocardial Infarction in the Middle East and North Africa: Rationale for the Gulf PREVENT Study

Angiology ◽

10.1177/0003319719849737 ◽

2019 ◽

Vol 71 (1) ◽

pp. 17-26

Author(s):

Sagar B. Dugani ◽

Waheed Murad ◽

Karisamae Damilig ◽

Jean Atos ◽

Eshraga Mohamed ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Middle East ◽

United Arab Emirates ◽

North Africa ◽

High Income ◽

Lower Prevalence ◽

Mena Region ◽

Vascular Events ◽

Coronary Syndrome

The Middle East and North Africa (MENA) region has a high burden of morbidity and mortality due to premature (≤55 years in men; ≤65 years in women) myocardial infarction (MI) and acute coronary syndrome (ACS). Despite this, the prevalence of risk factors in patients presenting with premature MI or ACS is incompletely described. We compared lifestyle, clinical risk factors, and biomarkers associated with premature MI/ACS in the MENA region with selected non-MENA high-income countries. We identified English-language, peer-reviewed publications through PubMed (up to March 2018). We used the World Bank classification system to categorize countries. Patients with premature MI/ACS in the MENA region had a higher prevalence of smoking than older patients with MI/ACS but a lower prevalence of diabetes, hypertension, and dyslipidemia. Men with premature MI/ACS had a higher prevalence of smoking than women but a lower prevalence of diabetes and hypertension. The MENA region had sparse data on lifestyle, diet, psychological stress, and physical activity. To address these knowledge gaps, we initiated the ongoing Gulf Population Risks and Epidemiology of Vascular Events and Treatment (Gulf PREVENT) case–control study to improve primary and secondary prevention of premature MI in the United Arab Emirates, a high-income country in the MENA region.

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Good Practices in the Clinical Management of Patients with Acute Coronary Syndrome: Retrospective Analysis in a Third-Level Hospital in Mexico

Cardiology Research and Practice ◽

10.1155/2020/9624283 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Héctor E. Flores-Salinas ◽

Fidel Casillas-Muñoz ◽

Yeminia Valle ◽

Cesar M. Guzmán-Sánchez ◽

Jorge Ramon Padilla-Gutiérrez

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Heart Surgery ◽

Coronary Intervention ◽

St Segment Elevation ◽

Coronary Syndrome ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Percutaneous Coronary

Introduction and Objective. In Mexico, there has been an increase in the risk of cardiovascular disease due to rising life expectancy, westernized lifestyle, lack of prevention, and industrialized exposure. This article describes the pharmacological treatment, surgical interventions, and associated clinical complications in patients diagnosed with acute coronary syndrome (ACS) and their impact on in-hospital mortality frequency in a Cardiology Unit in Instituto Mexicano del Seguro Social. Methods. This is a retrospective study including male and female patients aged ≥18 years who were diagnosed with ACS. The collected data included demographic characteristics, risk factors, medications, electrocardiograms, surgical procedures, and in-hospital deaths. Results. There are at least 20% more diagnoses of ST-segment elevation myocardial infarction in this hospital compared to the latest national reports in Mexico. The most common risk factors were type 2 diabetes mellitus, hypertension, smoking, and dyslipidaemia. Diabetic patients with a clinical history of percutaneous coronary intervention had a higher risk of non-ST-segment elevation myocardial infarction than nondiabetics (OR: 2.34; p=0.013), also smoking patients with previous heart surgery than nonsmokers (OR: 7.73; p=0.0007). The average in-hospital mortality was 3.6% for ACS. Conclusions. There is a higher percentage of coronary interventionism and improvement in pharmacological treatment, which is reflected in lower mortality. The substantial burden of T2DM could be related to a higher number of cases of STEMI. Diabetics with precedent percutaneous coronary intervention and smokers with previous heart surgery have an increased risk of subsequent infarction.

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Acute Coronary Syndrome in Pregnancy

Clinical medicine Cardiology ◽

10.4137/cmc.s3284 ◽

2009 ◽

Vol 3 ◽

pp. CMC.S3284 ◽

Cited By ~ 2

Author(s):

Douglas Wright ◽

Claire Kenny-Scherber ◽

Alison Montgomery ◽

Omid Salehian

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Present Report ◽

Rare Event ◽

Physiological Changes ◽

Coronary Syndrome ◽

Incidence Risk ◽

St Elevation ◽

In Pregnancy

Acute coronary syndrome (ACS) in pregnancy has traditionally been considered to be a rare event, but the combination of normal physiological changes of pregnancy and more prevalent cardiovascular risk factors are increasing its incidence in this population. The present report describes a 39 year-old woman that is seven weeks pregnant presenting with a non ST elevation myocardial infarction. The incidence, risk factors, pathophysiology and management of ACS in pregnancy are discussed.

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Myocardial infarction at a young age: risk factors, clinical presentation, features of management in the hospital

Clinical Medicine (Russian Journal) ◽

10.30629/0023-2149-2021-99-1-58-62 ◽

2021 ◽

Vol 99 (1) ◽

pp. 58-62

Author(s):

V. I. Denisov ◽

K. G. Pereverzeva ◽

D. Y. Boyakov ◽

A. D. Chuchunov ◽

D. A. Khazov

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Thrombolytic Therapy ◽

Young Patients ◽

Coronary Intervention ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment ◽

Percutaneous Coronary

Aim: to study the risk factors, clinical peculiarities, diagnosis and treatment of young patients with myocardial infarction (≤ 44 years).Material and methods. The research included 189 patients, who had MI in the period from January 1, 2015 to December 31, 2019 at the age of ≤ 44; 92.1% of patients were men. The average age of all patients was 41,2 (37.3; 43.6).Results. Most frequent risk factors for the development of MI were: smoking — in 77.8%, essential hypertension — in 73.5%, burdened inheritance — in 49.2%, obesity — in 39.7% and pancreatic diabetes — in 10.6% of all cases. ST segment elevation was registered on the electrocardiogram in 87,8% of patients; 4.2% of them had only thrombolytic therapy; thrombolytic therapy was followed by coronarography with the intention of performing percutaneous coronary intervention (PCI) in 30.7% of cases; coronarography with the intention of performing primary PCI was applied to 54.2% of patients. PCI was performed in 76.5% of patients. 12.2% of patients had acute coronary syndrome without ST-segment elevation, and 95.7% of them had coronarography with the intention of performing percutaneous coronary intervention. PCI was performed in 73.9% of patients. Assignment frequency of beta-adrenergic blocking agent prescription was 95,2% (178 out of 187), аngiotensin-convertingenzyme inhibitors and sartans — 95.2% (178 out of 187), statins — 99.5% (188 of 189), dual antiplatelet therapy — 99.5% (188 out of 189), mineral corticoid receptor antagonists with ejection fraction of left ventricle of heart ≤ 40% — 28.6% (2 of 7).Conclusion. The conducted research aims at the discussion of the vital topic of young patients with myocardial infarction management. It focuses on risk factors, clinical and angiographic presentation, and secondary prevention.

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Relationship between the Severity of Coronary Artery Disease and Cardiovascular Risk Factors in Acute Coronary Syndrome: Based on Tehran Heart Center’s Data Registry

The Journal of Tehran University Heart Center ◽

10.18502/jthc.v15i4.5942 ◽

2021 ◽

Author(s):

Negar Omidi ◽

Saeed Sadeghian ◽

Mojtaba Salarifar ◽

Arash Jalali ◽

Seyed Hesameddin Abbasi ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Myocardial Infarction ◽

Coronary Artery Disease ◽

Acute Coronary Syndrome ◽

Coronary Artery ◽

Family History ◽

Gensini Score ◽

Coronary Syndrome ◽

Artery Disease

Background: Acute coronary syndrome (ACS) is one of the main causes of mortality worldwide. We sought to evaluate the correlation between the severity of coronary artery disease (CAD) and conventional coronary artery risk factors in a large cohort of patients with ACS. Methods: This study included all patients admitted to the coronary care unit with a diagnosis of ACS between 2003 and 2017. The patients were divided into 2 groups: 1) unstable angina and 2) myocardial infarction. The aims of this study were to evaluate the effects of the risk factors and extension of coronary artery stenosis in patients with ACS according to the Gensini score. Results: Of a total 40 319 patients who presented with ACS, 18 862 patients (mean age =60.4±11.14 y, male: 67.2%) underwent conventional coronary angiography and met our criteria to enter the final analysis. The median of the Gensini score was 50 (25–88) in the study population. The multivariable analysis showed that age, sex, diabetes mellitus, hypertension, dyslipidemia, family history, cigarette smoking, opium consumption, and myocardial infarction increased the risk of positive Gensini scores. All the aforementioned risk factors, except cigarette smoking and opium consumption, increased the severity of stenosis in those with positive Gensini scores. The strongest relationship was seen vis-à-vis myocardial infarction, sex, and diabetes mellitus. Conclusion: Our findings suggest that age, sex, diabetes mellitus, dyslipidemia, hypertension, family history, and myocardial infarction have significant effects on the severity of CAD. The obesity paradox in relation to CAD should be taken into consideration and needs further investigation in patients with ACS.

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Caronary Artery Disease in Women

Journal of Medicine ◽

10.3329/jom.v15i2.20687 ◽

2014 ◽

Vol 15 (2) ◽

pp. 135-140

Author(s):

NS Neki

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Cardiovascular Disease ◽

Coronary Artery Disease ◽

Acute Coronary Syndrome ◽

Coronary Artery ◽

Coronary Disease ◽

Coronary Syndrome ◽

Artery Disease ◽

Prevalent Form

Coronary artery disease (CAD) - which includes coronary atherosclerotic disease, myocardial infarction (MI), acute coronary syndrome and angina - is the most prevalent form of cardiovascular disease and is the largest subset of this mortality. Coronary artery disease (CAD) is a leading cause of death of women and men worldwide. CADs impact on women traditionally has been underappreciated due to higher rates at younger ages in men. Microvascular coronary disease disproportionately affects women. Women have unique risk factors for CAD, including those related to pregnancy and autoimmune disease.DOI: http://dx.doi.org/10.3329/jom.v15i2.20687 J MEDICINE 2014; 15 : 135-140

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Level of Serum Uric Acid Along with Other Demographic Parameters in Patients with Acute Coronary Syndrome : A Study of 55 Cases from Chittagong

Chattagram Maa-O-Shishu Hospital Medical College Journal ◽

10.3329/cmoshmcj.v13i2.21070 ◽

2014 ◽

Vol 13 (2) ◽

pp. 55-58

Author(s):

Hasan Murad ◽

Rajiv Dey ◽

Md Atiquel Islam Chowdhury ◽

Hridi Hedayet Ullah ◽

Md Abdur Rouf

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Uric Acid ◽

Unstable Angina ◽

Serum Uric Acid ◽

Troponin I ◽

Elevated Serum ◽

Common Finding ◽

Coronary Syndrome

The association between serum uric acid and ischemic heart disease remains controversial and it has been difficult to identify the specific role of elevated serum uric acid because of its association with established cardiovascular risk factors such as hypertension, diabetes mellitus, hyperlipidaemia and obesity. Our objective was to study the association of serum uric acid level with confirmed cases of Acute Coronary Syndrome i.e. Unstable Angina, Acute Myocardial Infarction(AMI). The study was conducted in Chittagong Medical College (CMC) & University of Science and Technology(USTC) and nearby diagnostic centre. The study was based on Patients with Acute Coronary Syndrome proved by ECG and/or raised serum Troponin I. The aim of the study was to determine the relationship between serum uric acid and Unstable angina or myocardial infacrtion. There were 35% males & 5% females. The mean age of respondent was 50 years and age ranges from 35 to 70 years. In this study 50 cases of diagnosed myocardial infarction were selected and subsequently investigated with ECG, Radiological and Echocardiographic investigations. Increased serum uric acid levels are a common finding in patients with high blood pressure, insulin resistance, obesity and Cardiovascular disease. The clinical findings, chest X-ray and ECG findings of patients with risk factors for myocardial infarction were extensively studied and the findings are consistent with findings stated in textbooks.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i2.21070

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Patient Characteristics, Risk Factors, and Disease Outcomes in Young Adults With St-Elevation Myocardial Infarction: Insights From The Kermanshah Acute Coronary Syndrome Registry

10.21203/rs.3.rs-959817/v1 ◽

2021 ◽

Author(s):

Soraya Siabani ◽

Leila Gholizadeh ◽

Hossein Siabani ◽

Nahid Saleh

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Density Lipoprotein ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Younger Adults ◽

Coronary Syndrome ◽

Disease Outcomes ◽

St Elevation

Abstract Background: Myocardial infarction in younger adults is an understudied research area. Objectives: This paper reports on characteristics, risk factors, and disease outcomes of young adults with St-elevation myocardial infarction (STEMI).Methods: This is a sub-analysis of data from the Kermanshah Acute Coronary Syndrome Registry, including all patients aged ≤45 with STEMI (n=247) registered in the registry from June 2017 to June 2019. Results: Patients aged ≤45 constituted 10.66% of all patients with STEM; the majority was male (91.8%), and the most common CVD risk factors included: smoking (56.7%), low high-density lipoprotein (55.5%), elevated triglyceride (44.4%), hypertension (38.2%), hypercholesterolemia (38.1%), elevated low-density lipoprotein (26.3%), and obesity (24.3%). Many patients (62.8%) received primary percutaneous coronary intervention (PCI), and in-hospital mortality was low at 0.8%. Conclusions: Younger adults should be screened for CVD risk factors, and are educated and supported to participate in programs that aim to reduce risk through risk factor modification.

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