scholarly journals The Influence of Sex on Navigating Acute Coronary Syndrome: A Hospital-Based Cohort Study in South Asia

2021 ◽  
Author(s):  
Udaya Ralapanawa ◽  
Parackrama Karunathilake ◽  
Charith Bandara ◽  
Prabhashini Kumarihamy ◽  
Sujeewa Gunaratne ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Unstable Angina ◽  
Alcohol Intake ◽  
Age Of Onset ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
Predominant Symptom ◽  
The Mean ◽  
The Right

Abstract BackgroundThe cardiovascular risk profile and adverse events following acute coronary syndrome (ACS) differ between the Sex, indicating the importance of studying the sex differences in factors associated with ACS.MethodsA cross-sectional descriptive study was performed among ACS patients presented to Teaching Hospital Peradeniya. An interviewer-administered prevalidated questionnaire was used to collect data, and analysis was done. ResultsA total of 789 patients were included, consisting of 40.4% females. The mean age of females (62.17±11.06) was higher than males (59.80±11.24) (p=0.004), and in females, the mean age for unstable angina (60.5±10.5) was lower than NSTEMI (63.8±12.5) (p=0.022) and STEMI (64.0±9.2) (p=0.026). The male-female composition for unstable angina (46.3% vs 53.7%) and STEMI (75.8% vs 24.2%) showed varied proportions. The mean BMI (24.95±4.40 kg m-3 vs 23.77±3.88 kg m-3) (p=0.008) and obesity (21.6% vs 13.8%) (p=0.048) was higher in females. Overweight (9.4% vs 8.8%) (p=0.048) and the waist-hip ratio (0.98±0.07 vs 0.94±0.10) (p=0.006) was higher in males. Family history of hypertension was higher in females (24.1% vs 17.0%) (p=0.014). Most of the females were co-morbid with diabetes (37.9%) (p=0.008), hypertension (59.8%) (p<0.001) and dyslipidaemia (40.3%) (p<0.001) than males. The prevalence of smoking and alcohol intake was significantly higher in males (p<0.001). The predominant symptom was chest pain (93.4%), regardless of Sex. Right chest pain was primarily present in females (8.0% vs 3.6%) (p=048), and radiation of pain to the right arm mainly occurred in males (18.2% vs 7.5%) (p=0.007). Vomiting and dyspnoea was higher in females (47.7% vs 38.4%, p=0.049 and 53.1% vs 43.2%, p=0.039). The delay in presentation to the hospital was more in females (6:04±6:02) than males (3:55±4:22) with STEMI. The commonest reason for the delay was not suspecting an ACS, and a three-wheeler was the primary mode of transport in both sexes without any sex difference. Only 7.0% was delayed due to the unavailability of a transport facility.ConclusionFemale and male patients with ACS show differences in the age of onset, the spectrum of ACS, comorbidities, anthropometric measurements, risk factors like smoking and alcohol intake, clinical presentation aspects and delay in presentation to the hospital.

Strangulated Morgagni hernia masquerading as an acute coronary syndrome

2021 ◽  
Vol 14 (7) ◽  
pp. e244045
Author(s):  
May Honey Ohn ◽  
Jun Rong Ng ◽  
Theviga Neela Mehan ◽  
Ng Pey Luen
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Surgical Repair ◽  
Bleeding Risk ◽  
Emergency Laparotomy ◽  
Morgagni Hernia ◽  
X Ray ◽  
Coronary Syndrome ◽  
The Right ◽  
Rule Out

Morgagni hernia is the rarest type of congenital diaphragmatic hernia, which can present late in adulthood. Here, we report a case of Morgagni hernia in an elderly woman who presented as an acute coronary syndrome with raised troponin level. X-ray of the chest (CXR) showed air–fluid level in the right lower hemithorax with loss of right diaphragmatic outline and subsequently confirmed strangulated Morgagni hernia with CT. She was treated with emergency laparotomy to reduce the hernia content and surgical repair with mesh done. In conclusion, Troponin can be falsely positive in Morgagni hernia patients, possibly due to strain on the heart by herniated bowel contents. Basic imaging such as a (CXR) is useful in the case of chest pain to rule out the non-cardiac causes. Although ‘time is the myocardium’ in the setting of all cases of chest pain with raised troponin, CXR should be done before treatment that poses bleeding risk and unnecessary delay in laparotomy.

scholarly journals ACUTE CORONARY SYNDROME;

2017 ◽  
Vol 24 (03) ◽  
pp. 409-413
Author(s):  
Naveed Aslam Lashari ◽  
Nadia Irum Lakho ◽  
Sarfaraz Ahmed Memon ◽  
Ayaz Ahmed ◽  
Muhammad Fahad Waseem
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Cross Sectional Study ◽  
P Value ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
Study Results ◽  
Artery Obstruction ◽  
Conventional Risk Factors ◽  
Typical Chest Pain

Introduction: ACS is defined as the cluster of symptoms arising due to the rapiddrop of blood flow to the heart because of coronary artery obstruction. It is stated that worldwidearound 17 million people die due to cardiovascular diseases of which half of the deaths arereported due to ACS. Chest pain is known to be the most leading factor associated with ACS.Objectives: To determine the frequency of acute coronary syndrome, its types and commoncontributing factors in patients presenting with typical chest pain in a secondary care hospital.Study Design: Cross sectional study. Setting: Medical Unit, PAF Hospital Mushaf Sargodha.Period: October 2013 to March 2014. Methodology: A total of 280 patients of either gender,aged 20 to 80 years presented with typical chest pain with or without conventional risk factorswere included in the study. Results: Majority (68.9%) was males and 31.1% were female. Acutecoronary syndrome was observed in 131(46.8%) patients. Out of these 131 patients, 55% hadNSTEMI, 28.2% had unstable angina and 16.8% had STEMI. A higher proportion of femaleswere found to have ACS as compared to males (75.9% vs 33.7%, P-value<0.0001). Out of131 patients, 40.5% were diabetic, 29.8% were hypertensive 16% were hyperlipidemic, while13.7% were smokers. Conventional risk factors except smoking were observed more in femalesas compared to males. Conclusion: Majority of patients with acute coronary syndrome werefemales and diabetic. NSTEMI was the most common type of ACS. Prevalence of conventionalrisk factors was found more in females with ACS.

scholarly journals Acute Coronary Syndrome and patient behavior factors in overcoming the event of chest pain in pre hospital phase

2020 ◽  
Author(s):  
Cipto Susilo ◽  
Mochammad Bagus Qomaruddin ◽  
Mellani Puji Fahrera
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Complex Disease ◽  
Sampling Technique ◽  
P Value ◽  
Behavioral Factors ◽  
Cross Sectional ◽  
Over The Counter ◽  
Coronary Syndrome ◽  
Design And Methods

Background: Acute coronary syndrome (ACS) is a complex disease induced by thrombosis, which causes unstable angina (UA), acute myocardial infarction (AMI) or sudden cardiac death. It is important to rapidly detect the presence of chest pain to conduct the pre-hospital phase. This study aims to analyze the behavioral factors of patients suffering from ACS in overcoming the incidence of chest pain in the prehospital phase. Design and Methods: The consecutive sampling technique and cross-sectional method were used to obtain data from a sample of 110 outpatient respondents at the Community- Integrated Health Center.Results: After the logistic regression test, a significant relationship was found between the occurrence of chest pain (Pvalue = 0.040), with compressive behavior factors, buying over the counter drugs (P-value = 0.001), massaging and rubbing with oil (P-value = 0.046). Conclusions: In conclusion, the significant behavioral factors associated with ACS sufferers in dealing with the occurrence of chest pain in the pre-hospital phase are due to the act of buying OTC drugs and the habit of massaging or rubbing with oil.

scholarly journals Perfil epidemiológico e clínico de pacientes com síndrome coronariana aguda

2018 ◽  
Vol 12 (2) ◽  
pp. 379
Author(s):  
Júlia Trevisan Martins ◽  
Maria José Quina Galdino ◽  
Alessandro Rolim Scholze ◽  
Júlia Jetarchuki Ribas ◽  
Luma Nascimento Silva ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Intervention ◽  
Cardiac Enzymes ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
The Mean ◽  
Epidemiological Profile ◽  
Program Version

RESUMOObjetivo: identificar o perfil epidemiológico, evolução clínica e desfecho de pacientes atendidos com diagnóstico de Síndrome Coronariana Aguda em um pronto-socorro. Método: estudo quantitativo, transversal e exploratório, no qual foram analisados 367 prontuários. Os dados foram registrados em formulário estruturado para identificar os dados sociodemográficos e analisados por meio do Programa SPSS - versão 16.0, em que se utilizou estatística descritiva por média e frequências relativas e absolutas. Resultados: a idade média foi de 62,1 anos e predominaram o sexo masculino, a raça branca e casados. A prevalência de infarto agudo do miocárdio foi de 84,5%, diagnosticado por eletrocardiograma, ecocardiograma e enzimas cardíacas seriadas. Os tratamentos mais realizados foram os medicamentos antiagregantes plaquetários (64,3%), cateterismo cardíaco (65,4%) e a intervenção coronariana percutânea (27,2%). A maioria teve alta hospitalar, porém a taxa de mortalidade foi de 13,2%. Conclusão: os resultados demonstraram a importância da caracterização desses atendimentos, visto que pode colaborar para o planejamento de políticas públicas e ações intervencionistas que visem à prevenção das doenças cardíacas, redução das comorbidades e início de tratamento precoce. Descritores: Doença das Coronárias; Síndrome Coronariana Aguda; Serviços Médicos de Emergência; Infarto do Miocárdio.ABSTRACTObjective: to identify the epidemiological profile, clinical evolution and outcome of patients treated with a diagnosis of Acute Coronary Syndrome in an emergency room. Method: a quantitative, cross-sectional and exploratory study, in which 367 medical records were analyzed. The data were recorded in a structured form to identify the sociodemographic data and analyzed through the SPSS Program - version 16.0, in which descriptive statistics were used by means of relative and absolute frequencies. Results: the mean age was 62.1 years and male, white and married participants were predominant. The prevalence of acute myocardial infarction was 84.5%, diagnosed by electrocardiogram, echocardiogram and serial cardiac enzymes. The most commonly performed treatments were antiplatelet drugs (64.3%), cardiac catheterization (65.4%) and percutaneous coronary intervention (27.2%). Most were discharged from hospital, but the mortality rate was 13.2%. Conclusion: the results showed the importance of the characterization of this type of care, since it can help in the planning of public policies and interventionist actions aimed at the prevention of heart disease, reduction of comorbidities and early treatment. Descriptors: Coronary Disease; Acute Coronary Syndrome; Emergency Medical Services; Myocardial Infarction.RESUMENObjetivo: identificar el perfíl epidemiológico, evolución clínica y desarrollo de pacientes atendidos con diagnóstico de Síndrome Coronario Agudo en un pronto-socorro. Método: estúdio cuantitativo, transversal y exploratorio, en el cual fueron analizados 367 prontuarios. Los datos fueron registrados en formulario estructurado para identificar los datos sociodemográficos y analizados por medio del Programa SPSS - versión 16.0, en que se utilizó estadística descriptiva por media y frecuencias relativas y absolutas. Resultados: la edad media fue de 62,1 años y predominaron el sexo masculino, la raza blanca y los casados. La prevalencia de infarto agudo del miocárdio fue de 84,5%, diagnosticado por eletrocardiograma, ecocardiograma y enzimas cardíacas seriadas. Los tratamientos más realizados fueron los medicamentos antiagregantes plaquetários (64,3%), cateterismo cardíaco (65,4%) y la intervención coronaria percutánea (27,2%). La mayoría tuvo alta hospitalario, sin embargo la taza de mortalidad fue de 13,2%. Conclusión: los resultados demostraron la importancia de la caracterización de esos atendimientos, ya que puede colaborar para el planeamiento de políticas públicas y acciones intervencionistas que busquen la prevención de las enfermedades cardíacas, reducción de las comorbidades e início de tratamiento precoz. Descriptores: Enfermedad Coronaria; Síndrome Coronario Agudo; Servicios Médicos de Urgencia; Infarto do Miocárdio.

scholarly journals Chest pain symptoms differences between diabetes mellitus and non-diabetes mellitus patients with acute coronary syndrome: A pilot study

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Halidah Manistamara ◽  
Yurike Olivia Sella ◽  
Sony Apriliawan ◽  
Mifetika Lukitasari ◽  
Mohammad Saifur Rohman
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Total Sample ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
Adequate Knowledge ◽  
Late Treatment ◽  
Risk Patients ◽  
Pain Symptoms

Background: Chest pain is considered one of the crucial indicators in detecting acute coronary syndrome (ACS), and one of the most common complaints frequently found in hospitals. Atypical characteristics of chest pain have prevented patients from being aware of ACS. Chest pain symptoms have become ambiguous, particularly for specific parameters, such as gender, diabetes mellitus (DM), or other clinical conditions. Therefore, it is critical for high-risk patients to have adequate knowledge of specific symptoms of ACS, which is frequently associated with late treatment or prehospital delay. Therefore, this study aims to identify the particular characteristics of chest pain symptoms in DM and non-DM patients with ACS.Design and Methods: This is a quantitative and non-experimental research, with the cross-sectional approach used to carry out the analytical observation at a general hospital from January-April 2019. Data were obtained from a total sample of 61 patients, comprising 33 ACS with DM and 28 ACS non-DM patients.Results: The result showed that the characteristic of patients with chest pain symptoms has a significant relation to DM and ACS. Therefore, non-DM patients with ACS are more likely to feel chest pain at moderate to a severe level, while ACS-DM patients are more likely to have low to moderate chest pain levels.Conclusion: The significant differences in the characteristics of chest pain in DM and non-DM patients suffering from acute coronary syndrome are the points of location of chest pain radiating to the neck and quality of pain.

scholarly journals Prevalence of Dyslipidemia in Patients with Acute Coronary Syndrome Admitted at Tertiary Care Hospital in Nepal: A Descriptive Cross-sectional Study

2020 ◽  
Vol 58 (224) ◽  
Author(s):  
Sahadeb Prasad Dhungana ◽  
Arun Kumar Mahato ◽  
Rinku Ghimire ◽  
Rupesh Kumar Shreewastav
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Cross Sectional Study ◽  
Lipoprotein Cholesterol ◽  
Low Density Lipoprotein Cholesterol ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
The Mean

Introduction: Dyslipidemia is one of the major risk factors for acute coronary syndrome. Dyslipidemiawith an increase in total cholesterol, low-density lipoprotein cholesterol, triglycerides and decrease inhigh-density lipoprotein cholesterol is one of the major risk factors for the acute coronary syndromeand alone account for more than 50% of population attributable risk. This study was conducted tofind out the prevalence of dyslipidemia. Methods: This descriptive cross-sectional study was conducted in 105 patients admitted at thetertiary care center with a diagnosis of acute coronary syndrome from July 2018 to March 2019 afterapproval from the institutional review committee (Ref no. 205/2018). Fasting serum lipid profilewas obtained within 24 hours of hospitalization with the convenient sampling method. Data wereanalyzed with the help of the Statistical Package for Social Sciences version 20. Point estimation at95% Confidence interval was calculated along with frequency and proportion for binary data. Results: Out of 105 people, dyslipidemia was present in 51 (48.6%). The mean age of the participantswas 59.19±12.69 years. The majority 81 (77.1%) were male. The mean total cholesterol, triglycerides,low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were 183.43±35.9 mg/dl, 140.59±46.83 mg/dl, 109.9±26.38 mg/dl and 41.17±4.78 mg/dl respectively. High total cholesteroland triglyceride were found in 34 (32.4%) each, low high-density lipoprotein in 31 (29.5%) and highlow-density lipoprotein in 22 (21%).  Conclusions: Dyslipidemia is a significant risk factor in patients with acute coronary syndromeand commonly associated with other risk factors. Careful attention to its management may help toreduce further events.

scholarly journals Comparison of the HEART and HEARTS3 scores to predict major adverse cardiac events in chest pain patients at the emergency department

2020 ◽  
pp. 102490792094407
Author(s):  
Hasan Aydin ◽  
Yasin Ozpinar ◽  
Ulas Karaoglu ◽  
Muhittin Issever ◽  
Huseyin Aygun ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Cardiac Events ◽  
Coronary Syndrome ◽  
Adverse Cardiac Events ◽  
The Mean

Introduction: The aim of this study was to determine the risk assessment of acute coronary syndrome and prediction of major adverse cardiac events by HEART (History, ECG, Age, Risk factors, Troponin) and HEARTS3 (HEART + 3S = Sex, Serial 2-h ECG, and Serial 2-h delta Troponin) scoring systems in patients admitted to the emergency department with chest pain. Methods: This is a single-center prospective cohort study. This study was conducted in patients admitted to the emergency department with chest pain, without ST-elevation myocardial infarction, who were 18 years or older, and agreed to participate in the study. The primary endpoint is the occurrence of major adverse cardiovascular events within 30 days. The receiver operating characteristic curve was used to assess the power of HEART and HEARTS3 scores to predict major adverse cardiovascular events. Results: The mean age of 239 patients was 47.91 ± 13.93 years and 72.4% (173) were male. Major adverse cardiovascular events developed in 20.1% (48) of the patients. The mean HEART and HEARTS3 scores of the patients with major adverse cardiovascular events (5.67 ± 1.46 and 9.38 ± 3.91, respectively) were both statistically and significantly higher than the scores of the patients without major adverse cardiovascular events (2.33 ± 1.44 and 2.22 ± 1.39; p = 0.001). The area under the curve values of HEART and HEARTS3 scores were found to be 0.943 (95% confidence interval: 0.905–0.968) and 0.990 (0.968–0.999), respectively. Conclusion: In our study, the power of HEARTS3 score to predict major adverse cardiovascular events was better in the risk assessment of acute coronary syndrome in patients admitted to the emergency department with chest pain compared to the HEART score. We think that patients with a low HEARTS3 score can be safely discharged from emergency department without further cardiac examination.

scholarly journals Serial changes in high-sensitivity troponin I levels indicate poorer prognosis in patients with suspected acute coronary syndrome who fail to reach a level greater than the 99th percentile

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Pareek ◽  
K.H Kragholm ◽  
C Byrne ◽  
J.L Pallisgaard ◽  
C.J Lee ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Unstable Angina ◽  
Primary Outcome ◽  
Troponin I ◽  
High Sensitivity ◽  
Coronary Syndrome ◽  
Event Risk ◽  
High Sensitivity Troponin ◽  
Prognostic Implications

Abstract Background According to the fourth universal definition of myocardial infarction (MI) consensus paper, patients with changing troponins who do not reach a concentration greater than the 99th percentile may still be at high risk and should be followed closely. Purpose To determine long-term prognostic implications of high-sensitivity troponin I (hs-TnI) levels and their relative change (Δ) from baseline in subjects with suspected acute coronary syndrome (ACS). Methods We conducted a retrospective cohort study through individual participant-level linkage between Danish national registries. Subjects with a final discharge diagnosis of acute MI, unstable angina, suspected MI, or chest pain from October 2013 through December 2016 who had a record of at least two serial hs-TnI (Dimension Vista®, Siemens Healthineers, Erlangen, Germany; 99th percentile: 45 ng/l) measurements during hospitalization comprised the study population. Kaplan-Meier analysis and multivariable Cox regression, incorporating the competing risk of death, were used to examine the prognostic implications of serial hs-TnI. Subjects were categorized according to whether their first and second hs-TnI were normal/elevated as well as Δhs-TnI and its direction, the latter using cut-offs for Δhs-TnI rises and/or falls of 20% and 50%, extrapolated from the recommendations for troponin T. The primary outcome was a composite of death from cardiovascular causes, recurrent MI, or repeat revascularization (i.e. not including the index event unless the patient died) at 12 months. Results A total of 14,514 individuals (mean age 62.2 years, 46.6% women) were included of whom 3407 (23.5%) had a final diagnosis of MI, 667 (4.6%) of unstable angina, and 10,440 (71.9%) of either suspected MI or chest pain. Median baseline hs-TnI was 15 ng/l (25.3% elevated), second hs-TnI 15 ng/l (29.4% elevated), Δhs-TnI 0%, and time between samples 6.2 hours. At 12 months, 909 (6.3%) first primary events had occurred. Baseline hs-TnI and Δhs-TnI both displayed a significant, non-linear association with the primary outcome (P&lt;0.001). The Figure shows the prognostic implications of serial hs-TnI. Overall, subjects with two consecutively elevated hs-TnI had the highest 12-month event risk (15.7%), followed by those who went from a normal to an elevated hs-TnI (9.9%), those who went from an elevated to a normal hs-TnI (4.2%), and those with two normal hs-TnI (2.7%). Most either had no significant Δhs-TnI (−20% to 20%: 74.9%) or a large positive Δhs-TnI (&gt;50%: 17.5%). Individuals with any Δhs-TnI (&gt;20% in either direction) had a worse prognosis than those without. This was also true for the group of individuals with two normal hs-TnI (event risk 7.8% in those with a Δhs-TnI &gt;20% versus 2.3% in those without, P&lt;0.001). Conclusions Δhs-TnI was an important determinant of poorer prognosis in subjects with suspected ACS, even among individuals who did not reach a concentration greater than the 99th percentile. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Characteristic differences of chest pain in male and female patients with acute coronary syndrome: A pilot study

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Yurike Olivia Sella ◽  
Halidah Manistamara ◽  
Sony Apriliawan ◽  
Mifetika Lukitasari ◽  
Mohammad Saifur Rohman
Keyword(s):  
Gender Differences ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Moderate Pain ◽  
Cross Sectional ◽  
Male And Female ◽  
Female Patients ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Pain Characteristics

Background: The typical sign or main symptom in acute coronary syndrome (ACS) patients is chest pain, which is an initial benchmark or early sign for diagnosis. Certain factors, such as gender differences, the presence of diabetes mellitus or other clinical conditions, may make the patient not realize they have ACS. Therefore, this study aims to identify the characteristics of chest pain symptoms in male and female patients with ACS.Design and Methods: This is a non-experimental quantitative study, namely analytical observation using a cross-sectional approach within 4 months (January-April 2019). Furthermore, the samples were 53 ACS patients (28 male and 25 female).Results: The chest pain characteristics that have a significant relationship with gender differences in ACS patients are shown based on the aspects of location, pain duration and quality. Male patients are more likely to feel pain at the left or middle chest, the duration is between <20 to >20 min with moderate pain quality, which tends to become severe, while females are more likely to feel pain at the chest which radiates to the neck and chin, the duration is usually >20 min, with mild to moderate pain quality.Conclusions: The result showed a significant difference in chest pain characteristics in male and female patients with ACS. Regarding location, duration and quality of chest pain, male ACS patients mostly have more typical symptoms, while females’ symptoms are atypical.

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