Estimation of Serum Ferritin Levels in Patients with Acute Coronary Syndrome in Amritsar, India

BACKGROUND India is leading the world in incidence, prevalence, complications and mortality due to coronary artery disease (CAD). Various risk factors for acute coronary syndrome (ACS) are diabetes, hypertension, dyslipidaemia, smoking and obesity. It has been proposed that high serum ferritin levels are associated with enhancement in myocardial ischaemic response along with decreased ischaemic threshold in the setting up of acute ischaemic conditions. In this study, we wanted to measure and compare serum ferritin levels in patients of acute coronary syndrome and healthy controls to know the association between serum ferritin levels and risk of acute coronary syndrome. METHODS 60 patients of acute coronary syndrome admitted at Sri Guru Ram Das Hospital, Vallah Sri Amritsar were taken as cases and 60 age and sex matched healthy controls were taken. Serum ferritin levels were measured in both the cases and controls and were compared. RESULTS Most of the patients of ACS were in the age group of 51 - 60 years. Hypertension was the most common risk factor observed followed by diabetes mellitus (DM). Mean serum cholesterol levels were higher in cases. The most common vessel involved in ACS was left anterior descending artery (LAD). The difference in mean serum ferritin levels of cases and controls was statistically significant with higher levels in cases as compared to controls. These patients also had higher risk of developing heart failure and had a longer hospital stay. CONCLUSIONS The difference between serum ferritin levels in cases of ACS and controls was statistically significant. People with raised serum ferritin levels are at a greater risk of developing ACS as compared to those with normal serum ferritin levels. KEYWORDS Acute Coronary Syndrome, Serum Ferritin, Systolic Function, Diastolic Function, Mortality, Hospital Stay

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An Atypical Presentation of Acute Coronary Syndrome

European Cardiology Review ◽

10.15420/ecr.2012.8.1.67 ◽

2012 ◽

Vol 8 (1) ◽

pp. 67

Author(s):

Syed Khurram Mushtaq Gardezi ◽

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Systolic Function ◽

Artery Bypass ◽

Left Ventricular Systolic Function ◽

Regional Wall Motion ◽

Dobutamine Stress ◽

Left Ventricular ◽

Ventricular Systolic Function ◽

Coronary Syndrome

A 61-year-old man was admitted to hospital with severe occipital headache and weakness and numbness of the left arm. His electrocardiograms showed changes hinting at acute coronary syndrome (ACS). However, in view of his clinical presentation, he underwent tests for likely subarachnoid haemorrhage, but this was ruled out. The next day, he was referred to cardiology. A transthoracic echocardiogram showed reduced left ventricular systolic function along with regional wall motion abnormalities involving inferoposterior walls. The patient was treated as per the protocol for ACS. A dobutamine stress echocardiogram confirmed inferior myocardial infarction with evidence of myocardial viability in the affected left ventricular segments. Subsequent investigations confirmed three-vessel coronary artery disease and reduced left ventricular systolic function. The patient underwent successful coronary artery bypass grafting.

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The effect of obstructive sleep apnoea on timing of acute coronary syndrome

European Heart Journal ◽

10.1093/ehjci/ehaa946.1363 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M.H Muhmad Hamidi ◽

H Sani ◽

M.A Ibrahim ◽

K.S Ibrahim ◽

A.B Md Radzi ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

High Risk ◽

Systolic Function ◽

Strong Association ◽

Multiple Logistic Regression Analysis ◽

Sleep Apnoea ◽

Neck Circumference ◽

Coronary Syndrome ◽

Obstructive Sleep ◽

Significant Difference

Abstract Background and objective Acute coronary syndrome (ACS) remains the principal cause of death in Malaysia. It is estimated about 20% of ACS occurs at nighttime during sleep between 12am to 6am. Factors associated with nocturnal ACS are unknown. Acute nocturnal pathophysiological response to obstructive sleep apnea (OSA) may increase risk of nocturnal ACS. We hypothesized that OSA risk is associated with timing of ACS onset. Methodology This study included 200 patients with ACS who underwent coronary angiogram for which the time of chest pain onset was clearly identified and divided into 2 groups; nocturnal ACS (12am-5.59am) and non-nocturnal ACS (6am–11.59pm). Two validated questionnaires, STOP-BANG and Epworth Sleepiness Scale (ESS) were self-administered by subjects to determine OSA risk. All subjects timing of ACS onset, OSA risk, demography, anthropometric measurements, comorbidities and echocardiographic characteristics were analyzed. Results Acute coronary syndrome occurs nocturnally in 19% of ACS patients. The prevalence of high risk OSA individuals among ACS patients is 43%. There is significantly higher prevalence of high risk OSA individuals in nocturnal ACS group of 95% compared to 30% of high risk OSA individuals in non-nocturnal ACS group (p=0.001). Nocturnal ACS patients was significantly younger (50.1±8.7yrs, p=0.001), had higher BMI (33.9±4.3kg/m2, p=0.005), waist circumference (106.7±10.3cm, p=0.003) and larger neck circumference (44.6±3.3cm, p=0.001) compared to non-nocturnal ACS group. These groups had similar prevalence of other comorbidities for ACS and showed no significant difference between left and right ventricular systolic function. In multiple logistic regression analysis, the most significant predictors for nocturnal ACS are OSA risk, neck circumference and age. Conclusion There is a strong association between high risk OSA individuals and nocturnal ACS onset. Patient with nocturnal ACS onset should be screened for OSA and prioritized for polysomnography. OSA prevalence according to ACS onset Funding Acknowledgement Type of funding source: None

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EVALUATION OF SERUM CREATININE LEVEL IN SUBCLINICAL HYPOTHYROIDISM

10.36106/gjra/0706438 ◽

2021 ◽

pp. 29-32

Author(s):

Deepa Thadani ◽

Manna Lal Kumawat ◽

Sarla Mahawar ◽

Ajay Jain

Keyword(s):

Serum Creatinine ◽

Subclinical Hypothyroidism ◽

Waste Product ◽

Muscle Metabolism ◽

Thyroid Stimulating Hormone ◽

High Serum ◽

Normal Serum ◽

Renal Physiology ◽

Healthy Controls ◽

Chemical Waste

Background: Hypothyroidism is a common endocrinal disorder caused by insufcient production of thyroid hormones. Subclinical hypothyroidism (SCH) can be dened as a state of high serum thyroid stimulating hormone (TSH) levels (less than 10µIU/ml) with normal serum free thyroxine (fT ) and triiodothyronine (fT ) levels in 4 3 the presence or absence of symptoms. Creatinine is a chemical waste product that is produced by muscle metabolism. Creatinine is produced from creatine, a molecule of major importance for energy production in muscles. Thyroid dysfunction can affect renal physiology and development, and on the other hand, kidney disorders can inuence thyroid function. This study was aimed to nd out the status of serum fT , fT ,TSH and serum creatinine levels in subclinical hypothyroid cases and 3 4 healthy controls. Materials and Methods: The present study is descriptive case control study, was conducted in the Department of Biochemistry, J.L.N. Medical College and Associated group of Hospitals, Ajmer (Raj.). 130 cases of subclinical hypothyroidism attending Medical OPD of J.L.N. Hospitals were included and 50 age-sex matched euthyroid controls were selected. Results: The mean serum creatinine levels were found to be signicantly high in subclinical hypothyroid cases(0.99 + 0.19 mg%) as compared to healthy controls (0.75 + 0.15 mg%), (p<0.0001). Conclusion: Serum creatinine can be used as a biomarker for early detection of subclinical hypothyroidism in general population to prevent the morbidity and mortality which are associated with hypothyroidism. Early diagnosis and intervention of subclinical hypothyroid and their cluster of risk factor can prevent the renal dysfunction.

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Study of Cardiac Troponin I level in Acute Coronary Syndrome and its correlation with Left Ventricular Systolic Function

Cardiovascular Journal ◽

10.3329/cardio.v12i1.43415 ◽

2019 ◽

Vol 12 (1) ◽

pp. 24-29

Author(s):

Mohammad Jakir Hossain ◽

Khondoker Asaduzzaman ◽

Solaiman Hossain ◽

Muhammad Badrul Alam ◽

Nur Hossain

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Cardiac Troponin ◽

Troponin I ◽

Systolic Function ◽

Left Ventricular ◽

Cardiac Troponin I ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Coronary Syndrome

Background: In the diagnosis of acute coronary syndrome, cardiac troponin I is highly reliable and widely available biomarker. Serum level of cardiac troponin I is related to amount of myocardial damage and also closely relates to infarct size. Our aim of the study is to find out the relationship between cardiac troponin I and left ventricular systolic function after acute coronary syndrome. Methods: Total of 132 acute coronary syndrome patients were included in this study after admission in coronary care unit of Sir Salimullah Medical College, Mitford Hospital. Troponin I level was measured at admission and left ventricular ejection fraction (LVEF) was measured by echocardiography between 12-48 hours of onset of chest pain. Results: There was negative correlation between Troponin I at 12 to 48 hours of chest pain with LVEF in these study patients. With a cutoff value of troponin I e”6.8 ng/ml in STEMI patients there is a significant negative relation between 12 to 48 hrs troponin I and LVEF (p<0.001). Sensitivity of troponin I e” 6.8 ng/ml between 12 to 48 hours of chest pain in predicting LVEF <50% in STEMI was 93.75% and specificity was 77.78%. In NSTEMI sensitivity of troponin I e” 4.5 ng/ml between 12 to 48 hours of chest pain in predicting LVEF <50% was 65% and specificity was 54.05%. Conclusion: Serum troponin I level had a strong negative correlation with left ventricular ejection fraction after acute coronary syndrome and hence can be used to predict the LVEF in this setting. Cardiovasc. j. 2019; 12(1): 24-29

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Caracterização do perfil e complicações intra-hospitalares dos pacientes submetidos ao cateterismo cardíaco em um hospital terciário

Scientia Medica ◽

10.15448/1980-6108.2017.1.24806 ◽

2017 ◽

Vol 27 (1) ◽

pp. 24806

Author(s):

Débora Ferreira Braga ◽

Gustavo Paes Silvano ◽

Thainá Ferreira Furtado Pereira ◽

Fabiana Schuelter-Trevisol ◽

Daisson José Trevisol

Keyword(s):

Diabetes Mellitus ◽

Acute Coronary Syndrome ◽

Hospital Stay ◽

Cardiac Catheterization ◽

Tertiary Care ◽

Care Hospital ◽

Puncture Site ◽

Coronary Syndrome ◽

Vessel Disease ◽

Triple Vessel Disease

DOI: 10.15448/1980-6108.2017.1.24806 Aims: To evaluate the profile of patients undergoing cardiac catheterization and in-hospital complications associated with the procedure.Methods: Cross-sectional analysis of baseline data of a retrospective cohort study conducted in a tertiary care hospital in southern Brazil between 2007 and 2013. The study included patients undergoing diagnostic or therapeutic cardiac catheterization. The data were extracted from electronic medical records using a standardized form and stored in a database for further analysis.Results: Out of 994 assessed patients, 584 (58.8%) were male. The mean age was 61.4 years. Hypertension was the most prevalent risk factor, followed by dyslipidemia and diabetes mellitus. Regarding clinical presentation, 550 (55.3%) patients had acute coronary syndrome, 402 (40.4%) had stable angina, and 42 (4.2%) were asymptomatic. Cineangiography was normal in 152 (15.3%) patients and abnormal in 842 (84.7%). Of these, 251 (29.8%) had single vessel disease, 190 (22.6%) had double vessel disease, and 401 (47.6%) had triple vessel disease. The overall incidence of complications was 15.6%, and 1% of the patients suffered some kind of major event (death during the procedure and neurological complications during their hospital stay). Other complications included acute kidney injury (1.4%) and local vascular complications (13.2%), mainly hematoma at the puncture site. Fifty (5%) patients died during the hospital stay, 46 (92%) of them from cardiac causes. Conclusions: The patients undergoing cardiac catheterization were predominantly male, with mean age of 61.4 years. The most frequent risk factors for cardiovascular disease included hypertension, dyslipidemia, and diabetes mellitus. Most of the patients had triple vessel disease. The main indication for the procedure was acute coronary syndrome. The overall incidence of complications was 15.6% with predominance of hematoma at the puncture site.

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Culture of the Aspirated Coronary Thromboembulus Specimen: A Peculiar Diagnostic Method for Infective Endocarditis

Case Reports in Medicine ◽

10.1155/2013/607393 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Massimo Slavich ◽

Andrea Fisicaro ◽

Eustachio Agricola ◽

Giovanni Coppi ◽

Carlo Ballarotto ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Infective Endocarditis ◽

Hospital Stay ◽

Transesophageal Echocardiography ◽

Diagnostic Method ◽

Definitive Diagnosis ◽

Clinical Scenario ◽

Persistent Fever ◽

Coronary Syndrome ◽

Articular Pain

A 69-year-old man was admitted to our hospital for persistent fever, myalgias, articular pain, headache, and hypoaesthesia of the scalp. The clinical scenario was typical for giant-cell arteritis. During hospital stay, patient developed fugax amaurosis, stroke, and acute coronary syndrome. The definitive diagnosis of infective endocarditis, supported by transesophageal echocardiography, was confirmed only by culturing the material obtained during angiography and coronary thromboaspiration.

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High Serum Resistin Level may be an Indicator of the Severity of Coronary Disease in Acute Coronary Syndrome

Chinese Medical Sciences Journal ◽

10.1016/s1001-9294(09)60082-1 ◽

2009 ◽

Vol 24 (3) ◽

pp. 161-166 ◽

Cited By ~ 31

Author(s):

Hao Wang ◽

De-you Chen ◽

Jian Cao ◽

Zuo-yun He ◽

Bing-po Zhu ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Disease ◽

High Serum ◽

Resistin Level ◽

Coronary Syndrome ◽

Serum Resistin Level

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Platelet-derived microparticles during and after acute coronary syndrome

Thrombosis and Haemostasis ◽

10.1160/th11-11-0779 ◽

2012 ◽

Vol 107 (06) ◽

pp. 1122-1129 ◽

Cited By ~ 49

Author(s):

Mika Skeppholm ◽

Fariborz Mobarrez ◽

Karin Malmqvist ◽

Håkan Wallén

Keyword(s):

Clinical Trials ◽

Acute Coronary Syndrome ◽

Platelet Activation ◽

Platelet Function ◽

Plasma Concentrations ◽

Healthy Controls ◽

Antithrombotic Treatment ◽

Coronary Syndrome ◽

Flow Cytometric ◽

Cell Fragments

SummaryAs microparticles are shedded upon platelet activation, and may be used to assess platelet function, we measured plasma concentrations of platelet-derived microparticles (PMPs) during and after an acute coronary syndrome (ACS). Fifty-one patients with ACS were investigated at admission, within 24 hours (before coronary angiography), and six months later. Sixty-one sex- and age-matched healthy controls were investigated once. PMPs were defined as particles <1.0 μm in size, negative to phalloidin (labels cell-fragments), and positive to CD61. Exposure of phosphatidylserine (PS+), CD62P and CD142 were also measured. Plasma concentrations of PS+PMPs exposing CD61, CD62P and CD142 were elevated 2.5, 6.0-, and 5.0-fold at admission (p<0.001 for all, compared to controls; aspirin only), decreased significantly 24 hours later following initiation of treatment with clopidogrel and subcutaneous anticoagulation (p<0.001 for all), and decreased even further six months later (p<0.01 for all). However, PS+PMPs exposing CD62P or CD142 were still between 1.2-and 2.3-fold higher than in controls (p<0.001 for both). The pattern for PS−PMPs during and after the ACS was very similar to that for PS+PMPs although the numbers were approximately 1/3 lower. In conclusion, PMP concentrations follow the pattern of platelet activation during and after an ACS. Decreased concentrations are observed after initiation of antithrombotic treatment, but PMP exposing CD62P or CD142 are still elevated after six months. Flow cytometric measurements of PMP in frozen-thawed samples enable studies of platelet function in larger clinical trials.

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Abstract MP093: Clinical Features, Treatment Practices, and Short-term Outcomes of Patients < 55 Years of Age Hospitalized with an Acute Coronary Syndrome: The Global Registry of Acute Coronary Events

Circulation ◽

10.1161/circ.125.suppl_10.amp093 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Hamza Awad ◽

Frederick A Anderson ◽

Gordon FitzGerald ◽

Joel Gore ◽

Robert Goldberg

Keyword(s):

Acute Coronary Syndrome ◽

Hospital Stay ◽

Clinical Features ◽

Young Patients ◽

Length Of Hospital Stay ◽

Hospital Death ◽

Odds Ratios ◽

Short Term ◽

Treatment Practices ◽

Coronary Syndrome

Limited data are available describing the magnitude, clinical features, treatment practices, and short-term outcomes of comparatively young adults hospitalized with acute coronary syndromes (ACS). The objectives of this large multinational observational study, using data from the GRACE Registry, were to describe nearly decade long trends in these endpoints among adults < 55 years old who were hospitalized with an ACS between 1999 and 2007. The overall proportion of young adult patients in our study population was 23% (n=15,052 of 65,119) and this proportion remained relatively constant over the study years. Baseline demographic and clinical characteristics of our study sample did not change significantly, whereas, the length of hospital stay declined by more than 1 day, on average, during the years under study. The overall in-hospital and 30-day multivariable adjusted case-fatality rates (CFRs) declined by approximately one-third (table) between 1999 and 2007 (crude 30-day CFR= 2.4% in 1999 and 1.7% in 2007). The use of evidence-based cardiac therapies demonstrated to improve outcomes of patients with an ACS increased significantly over time. In conclusion, improving trends in short-term outcomes of comparatively young patients hospitalized with an ACS during the nearly decade long period under study likely reflect enhanced primary and secondary prevention and treatment efforts. Odds of Dying in Younger Patients Hospitalized with an Acute Coronary Syndrome Study Period Crude Odds Ratios of In-Hospital Death Multivariable Adjusted Odds Ratios of In-Hospital Death * Crude Odds Ratios of 30-day Death Multivariable Adjusted Odds Ratios of 30-day Death * 1999-2001º 1.0 1.0 1.0 1.0 2002-2004 0.89 (0.82-0.97) 0.83 (0.76-0.91) 0.93 (0.86-1.0) 0.83 (0.76-0.90) 2005-2007 0.74 (0.67-0.81) 0.66 (0.60-0.74) 0.74 (0.68-0.81) 0.62 (0.57-0.69) * Adjusted for age, sex, length of hospital stay, and medical history ºreferent period

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Abstract 2601: Increased TLR-4+ Monocytes in Thrombi from the Site of Coronary Occlusion in Acute Coronary Syndromes - a Role for Innate Immunity in Acute Coronary Syndrome

Circulation ◽

10.1161/circ.116.suppl_16.ii_576-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Michel Neidhart ◽

Christophe Wyss ◽

Lukas Altwegg ◽

Keiko Yonekawa ◽

Franz Eberli ◽

...

Keyword(s):

Innate Immunity ◽

Acute Coronary Syndrome ◽

Peripheral Blood ◽

Coronary Occlusion ◽

Adherent Cells ◽

Healthy Controls ◽

Coronary Syndrome ◽

Coronary Syndromes ◽

The Mean ◽

Shock Proteins

Objective: To evaluate and compare the expression of Toll-like receptors 2 and 4 (TLR-2 and -4) in thrombi obtained at the site of coronary occlusion of patients with acute coronary syndrome (ACS) with their expression in peripheral blood (PBL) of the same patients and healthy controls. Methods: Thrombi were mechanically disrupted, treated with actilyse for 12 hours in RPMI + 10% FCS. The amount of erythrocytes was reduced by isotonic lysis. Peripheral blood from the same patients (n = 14) and from age- and sex-matched healthy controls (n = 10) were treated in the same manner. Adherent cells were detached by Accutase and mixed with the non-adhering cells. CD14+ and CD66b+ (FITC) cells were stained for TLR-2 and TLR-4 (PE) and analysed by flow cytometry. Results: TLR-4 was detected in the thrombi by immunohistochemistry. The proportion of TLR-4+ cells was markedly increased in the monocyte gate of cells isolated from the thrombus, in comparison to peripheral blood cells from the same patient or healthy controls. Most importantly, the expression of TLR-4, measured as the mean fluorescence intensity, was significantly elevated on CD14+ monocytes of the thrombus, compared to peripheral blood CD14+ cells from the same patient or healthy controls (Figure 1 ). No such differences could be found for expression of TLR 2, TLR 3 or TLR 9. Conclusion: Thrombi of patients with ACS contain an increased proportion of TLR-4+ monocytes. Thus, our results suggest that activation of innate immunity through TLR-4 is involved in ACS. This may be a part of a link between induction of heat shock proteins and thrombosis.

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