scholarly journals Clinical presentation and treatment in patients with acute coronary syndrome in a tertiary care general hospital in Bangladesh

2018 ◽  
Vol 4 (1) ◽  
pp. 117-122
Author(s):  
Monalisa Monwar ◽  
Ambia Khatun ◽  
Masud Parvez ◽  
Tarannum Naz ◽  
Mir Imam Ibne Wahed ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
General Hospital ◽  
Troponin I ◽  
Tertiary Care ◽  
Treatment Strategies ◽  
Acute Chest Pain ◽  
Average Hospital ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Depression

Acute coronary syndrome (ACS) is a leading cause of death among people in Bangladesh. The aim of the study was to analyze the clinical course and treatment strategies in patients with ACS and to determine to what extent management of ACS in a tertiary care general hospital in Bangladesh adhered to current guidelines. This study was carried out in the coronary care unit (CCU) of a tertiary care general hospital, Rajshahi, for a period of 3-months. A total number of 240 patients presenting with ACS were included in our study and the most common symptoms were acute chest pain (90%) and dyspnea (49%). The study group comprised of 27% female and 73% male patients with varying risk factors including hypertension (45%), hyperlipidemia (43%), family records of coronary artery disease (CAD) (20%), diabetes (17%) and smoking (15%). The most frequent ECG finding in patients was T wave change (71%), pathological Q wave (67%), ST segment elevation (33%), ST depression (9%), whereas, 12% patients with ACS reported to have normal ECG. Patients with ACS had elevated levels of SGOT and CK-MB. Troponin I level was positive in 100% of the patients with a mean peak troponin level of 1.5± 0.15ng/ml. In clinical setting, the patients were immediately managed with isosorbidedinitrate (58%), streptokinase (40%) and intravenous heparin (LMWH) followed by (46%) and (54%) of aspirin and aspirin-clopidogrel combinations respectively. In addition, long-term management with antihypertensive included β-blocker (58%), calcium channel blocker (29%), ACE-I (25%) and diuretics (12%). Anti-diabetic (18%) drugs were also prescribed in patients with co-existing diabetes and CAD. Adherence to guidelines is limited by lack of funds and resources in the hospital; however, attention must be paid to improve patient outcome. The average hospital stay ranges 2-3 days and hospital mortality was 10%.Asian J. Med. Biol. Res. March 2018, 4(1): 117-122

scholarly journals Takotsubo syndrome in elderly woman: The diagnosis by transthoracic echocardiography

2019 ◽  
Vol 7 ◽  
pp. 2050313X1987892
Author(s):  
Inggita Hanung Sulistya ◽  
Anggoro Budi Hartopo ◽  
Lucia Kris Dinarti ◽  
Budi Yuli Setianto
Keyword(s):  
Acute Coronary Syndrome ◽  
Left Ventricle ◽  
Transthoracic Echocardiography ◽  
Troponin I ◽  
Acute Chest Pain ◽  
Apical Ballooning ◽  
Transient Condition ◽  
Takotsubo Syndrome ◽  
Coronary Syndrome ◽  
Concentric Hypertrophy

Takotsubo syndrome has increasingly been recognized in the differential diagnosis of patients presenting with acute chest pain. Those affected are typically older women suffering after an emotional or physical stress. Normally it is a transient condition but complications including death have been reported. We reported a case of takotsubo syndrome who was initially diagnosed as acute coronary syndrome. The patient presented with typical angina, ST-T segment changes, and elevated high sensitive–troponin I. Coronary angiography showed normal coronary arteries. Transthoracic echocardiography revealed mild left atrial dilatation and left ventricle concentric hypertrophy, reduced left ventricle ejection fraction with circumferential hypokinetic, apical ballooning, systolic anterior motion, left ventricle outflow tract obstruction, and sigmoid septum hypertrophy. One month later, patient recovered and transthoracic echocardiography revealed improved heart anatomy and function. To differentiate takotsubo syndrome with other conditions, especially acute coronary syndrome, is crucial. Their clinical presentations are similar but the managements are different. The transthoracic echocardiography holds an important role in supporting the diagnosis of takotsubo syndrome.

scholarly journals COMPARATIVE ANALYSIS OF VARIOUS RISK ASSESSMENT SCORES FOR LOW RISK ACUTE CORONARY SYNDROME IN AN INDIAN SCENARIO – AN ED BASED OBSERVATIONAL STUDY.

2019 ◽  
Vol 3 (11) ◽  
Author(s):  
Zahid Shaikh ◽  
V. S. Shinde ◽  
Sumalya Tripathi ◽  
Dhiraj Jadhav ◽  
Ishan Lamba ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Tertiary Care ◽  
Acute Chest Pain ◽  
Industrial Area ◽  
Low Risk ◽  
Cardiac Biomarkers ◽  
Assessment Scores ◽  
Heart Score ◽  
Coronary Syndrome

Chest pain is one of the most common presentation to emergency department (ED). The misdiagnosis or over-diagnosis of patients with acute chest pain can be associated with serious clinical events or is time-consuming and this places a heavy burden on overcrowded and resource constraint ED. To help overcome this issue various scores are formed to rule out acute coronary syndrome (ACS) in these patients. Those who do not meet the criteria of high risk ACS like raised cardiac biomarkers, ECG changes, etc are labeled as low risk ACS. These patients form the majority of patients. A multitude of risk score have been formulated to predict the outcome and risk stratify patients with chest pain. Our objective was to evaluate the utility of these score in Indian setting in low risk ACS patients. We studied the various risk prediction score of 100 patients presenting to the ED of tertiary care teaching institute in an urban industrial area with low risk ACS. The scores that were calculated included HEART, TIMI, ADAPT, GRACE, NACPR and EDACS. Of all the scores only the HEART score correlated well with identifying those who required further testing. Taking a score of less than 3 as a marker of low risk ACS we get a sensitivity of 95.83% (95CI - 89.67% to 98.85%) and specificity of 100%. The PPV is 100% and accuracy of 96%. All other scores were either not specific enough or had limited utility. Keywords: Low risk ACS, ACS, HEART, TIMI, ADAPT, GRACE, NACPR, EDACS

scholarly journals Heart Score for Predicting in Hospital Major Cardiovascular Event in Patient with Non ST Segment Elevation Acute Coronary Syndrome

2020 ◽  
Vol 6 (2) ◽  
pp. 85-90
Author(s):  
Kamal Kharrazi Ilyas ◽  
Sutomo Kasiman ◽  
Harris Hasan ◽  
Zulfikri Mukhtar ◽  
Refli Hasan ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
General Hospital ◽  
Cardiovascular Event ◽  
Roc Curve ◽  
Predictive Value ◽  
Predictive Ability ◽  
St Segment Elevation ◽  
Heart Score ◽  
Coronary Syndrome ◽  
St Segment

Background: Acute Coronary Syndrome (ACS) is one of the main problems in the field of cardiovascular diseases because of high hospitalization rate, high mortality and high medical cost. Rapid and accurate risk stratification is needed to calculate the risk of complication and right now exist two most used score which is GRACE and TIMI. Heart score has 5 simple variables that can be calculated easily and this score considered to have better predictive ability compared to other score. The aim of this study is to examine HEART score as a predictor for in hospital Major Cardiovascular Event (MACE) in patient diagnosed as Non ST Segment Elevation Acute Coronary Syndrome (NSTEACS) that hospitalized at Haji Adam Malik (HAM) General Hospital Medan. Methods: This is a prospective cohort study that includes 52 NSTEACS patient that hospitalized at HAM General Hospital since November 2018 until January 2019. Patient that diagnosed as NSTEACS were calculated for GRACE, TIMI, and HEART score then observed during hospitalization. Outcome of this study is MACE during hospitalization. Statistical analysis was performed to test HEART score as MACE predictor and then comparison was done with GRACE and TIMI Results: By using ROC curve analysis, the cut-off value of HEART score was 5 (AUC 0.947, 95% CI 0.883-0.997, p<0.01). Study subject that experienced MACE with HEART score ≥5 was 21 patients (87.5%) compared to 2 patients (7.1%). HEART score ≥5 can predict MACE with sensitivity 87.5%, specificity 92.9%, negative predictive value (NPV) 89.7% and positive predictive value (PPV) 91.3%. ROC curve comparison was done between HEART with GRACE and TIMI then it was found that HEART score has better predictive ability compared to TIMI and GRACE (AUC 0.947 vs 0.829 vs 0.807, p < 0.01). Conclusion: HEART score can be used as MACE predictor which is relatively simpler but have better predictive ability compared to GRACE and TIMI.

scholarly journals Can troponin I measurement predict short-term serious cardiac outcomes in patients presenting to the emergency department with possible acute coronary syndrome?

CJEM ◽  
2004 ◽  
Vol 6 (01) ◽  
pp. 22-30 ◽  
Author(s):  
Stephen A. Hill ◽  
P.J. Devereaux ◽  
Lauren Griffith ◽  
John Opie ◽  
Matthew J. McQueen ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Troponin I ◽  
Tertiary Care ◽  
Cardiovascular Death ◽  
Care Hospital ◽  
Likelihood Ratios ◽  
Coronary Syndrome ◽  
Cardiac Outcomes ◽  
Cardiac Outcome

ABSTRACT Objective: To determine the ability of troponin I (TnI) measurement to predict the likelihood of a serious cardiac outcome over the subsequent 72 hours in patients presenting to the emergency department (ED) with symptoms suggestive of an acute coronary syndrome. Methods: This prospective observational study enrolled consecutive patients presenting to 2 urban tertiary care hospital EDs over a 5-week period. Eligible patients included those for whom a TnI test was ordered within 24 hours of arrival and in whom no serious cardiac outcome occurred before the test result was available. Patients were followed for 72 hours and serious cardiac outcomes documented; these included cardiovascular death, myocardial infarction, congestive heart failure, serious arrhythmia and refractory pain. We calculated likelihood ratios (LRs) to describe the association of the TnI result with serious cardiac outcomes. Results: Of the 352 enrolled patients, 20 had a serious cardiac outcome within 72 hours of ED presentation. The derived LRs (and 95% confidence interval [CI]) were 0.5 (0.3–0.9) for TnI values &lt;0.5 µg/L, 1.6 (0.4–6.5) for TnI values from 0.5 to 2.0 µg/L, 5.8 (1.7–19.5) for TnI values from &gt;2.0 to 10.0 µg/L and 14.4 (4.8–42.9) for TnI values &gt;10.0 µg/L. Conclusions: TnI values &gt;2.0 µg/L are associated with an increased probability of serious cardiac outcomes within 72 hours. TnI values between 0.5 and 2.0 µg/L are weakly positive predictors. TnI values &lt;0.5 µg/L have LRs in the range of 0.5 and thus are weakly negative predictors, not substantially decreasing the likelihood of serious cardiac outcomes, particularly in patients with a moderate or high pretest probability.

scholarly journals The Importance of Age and Statin Therapy in the Interpretation of Lp-PLA2 in ACS Patients, and Relation to CRP

2015 ◽  
pp. 229-245
Author(s):  
J. FRANEKOVÁ ◽  
J. KETTNER ◽  
Z. KUBÍČEK ◽  
A. JABOR
Keyword(s):  
Acute Coronary Syndrome ◽  
Statin Therapy ◽  
Troponin I ◽  
Acute Chest Pain ◽  
Final Diagnosis ◽  
C Reactive Protein ◽  
Plaque Instability ◽  
Reactive Protein ◽  
Coronary Syndrome ◽  
History Of

C-reactive protein (CRP) is a marker of arterial inflammation while lipoprotein-associated phospholipase A2 (Lp-PLA2) is related to plaque instability. The aim of this study was to evaluate the correlation between the risk of unstable plaque presenting as acute coronary syndrome (ACS) and Lp-PLA2, and to assess the influence of statins on interpretation of Lp-PLA2. A total of 362 consecutive patients presenting to the emergency department (ED) with acute chest pain suggestive of ACS were evaluated by cardiologists as STEMI, NSTEMI, or unstable angina, and non-ACS. Serum biomarkers measured on admission: troponin I, C-reactive protein (Abbott), and Lp-PLA2 (DiaDexus). Four groups were defined according to the final diagnosis and history of statin medication: ACS/statin−; ACS/statin+; non-ACS/statin−; non-ACS/statin+. Lp-PLA2 was highest in ACS/statin− group; statins decreased Lp-PLA2 both in ACS and non-ACS of about 20 %. Lp-PLA2 was higher in ACS patients in comparison with non-ACS patients group without respect to statin therapy (p<0.001). Lp-PLA2 predicted worse outcome (in terms of acute coronary syndrome) effectively in patients up to 62 years; limited prediction was found in older patients. C-reactive protein (CRP) failed to discriminate four groups of patients. Statin therapy and age should be taken into consideration while interpreting Lp-PLA2 concentrations and lower cut-off values should be used for statin-treated persons.

scholarly journals Correlation and Prognostic Significance of Electrocardiography, Echocardiography and Troponin in Patients Admitted with NSTEMI

2021 ◽  
Author(s):  
Dileep Kumar ◽  
Tahir Saghir ◽  
Kamran Ahmed Khan ◽  
Muhammad Naeem Mengal ◽  
Khalid Naseeb ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Troponin I ◽  
Tertiary Care ◽  
Prognostic Significance ◽  
St Segment Elevation ◽  
St Depression ◽  
Wave Inversion ◽  
St Segment ◽  
Electrocardiographic Changes ◽  
The Relationship

Abstract Background: Non ST segment elevation myocardial infarction (NSTEMI) is a clinical condition characterized by typical symptoms of myocardial ischemia along with electrocardiographic changes and a positive value of troponin. After presentation in emergency department these patients have their troponin I value and electrocardiography done. The echocardiography should also be performed in these patients. This study was conducted to determine the relationship between ECG, Echo and troponin and how prognostically these are relevant to each other along with their prognostic significance.Results: This observational study was conducted at tertiary care cardiac hospital on 221 patients diagnosed with the NSTEMI. The most frequent finding on presenting ECG was ST depression in anterior leads (V1-V6) in 27.6%. Median troponin I at presentation was 3.2 ng/dl and median ejection fraction was 45%. Overall all-cause mortality rate at 6-months was observed to be 8.6%, re-infarction in 5%, re-hospitalization in 16.3%, and heart failure in 25.3% was observed. However, mortality was higher for patients with baseline ECG findings of A-fib, generalized ST-depression , poor R-wave progression, Wellens sign, and T-wave inversion in inferior also mortality rate was relatively higher among patients with poor (<30%) LVEF. Conclusion: ECG and Echocardiography were prognostically significant and correlated better at 6 months. However Troponin lacks the association and prognostic significance at 6 months.

scholarly journals Hypercalcemia-Induced ST-Segment Elevation Mimicking Acute Myocardial Injury: A Case Report and Review of the Literature

2020 ◽  
Vol 2020 ◽  
pp. 1-5 ◽  
Author(s):  
Ashraf Abugroun ◽  
Aneesh Tyle ◽  
Farah Faizan ◽  
Michael Accavitti ◽  
Chaudhary Ahmed ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Calcium Level ◽  
Troponin I ◽  
Cell Cancer ◽  
Acute Pericarditis ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Parathyroid Hormone Related Protein ◽  
Severe Hypercalcemia ◽  
St Segment

ST-segment elevation in absence of acute coronary syndrome can be seen in multiple conditions, including acute pericarditis and coronary vasospasm, but it is rarely seen with severe hypercalcemia. The authors present a case of an 81-year-old female with a history of stage 4 squamous cell cancer of the lung, who presented to the emergency room with profound fatigue, weakness, anorexia, and drowsiness two weeks after her first chemotherapy cycle. Additionally, she had complaints of right-sided chest pain associated with worsening shortness of breath, as well as right arm numbness. An EKG obtained on arrival to the hospital showed diffuse ST-segment elevation (leads V3–V6, I, II, III, and aVF). Basic lab work found a calcium level of 20.4 mg/dl with elevated parathyroid hormone-related protein (PTHrP) of 135 pg/ml. Troponin I remained within normal limits. Serial EKS obtained during the patient’s hospitalization demonstrated resolution of the ST elevation as calcium level normalized. This case emphasizes the importance of hypercalcemia as a differential diagnosis for ST-segment elevation and QT shortening when acute coronary syndrome is not present. Awareness of these EKG changes is critical for early diagnosis, recognition, and appropriate treatment.

scholarly journals Characteristics and 1-year prognosis of non-obstructive acute coronary syndrome

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
JM Viegas ◽  
AV Goncalves ◽  
I Cardoso ◽  
SA Rosa ◽  
AT Timoteo ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Disease ◽  
Tertiary Care ◽  
Total Mortality ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Tertiary Care Centre ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Coronary Syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Among patients admitted at catheterization laboratory with suspicion of acute coronary syndrome (ACS) a minority have no obstructive epicardial coronary disease (MINOCA).  The characteristics and outcomes of this subgroup remains unclear. Purpose The aim of the present study is to characterize MINOCA patients and assess the 1-year prognosis regarding total mortality. Methods A standardized registry was prospectively performed for all ACS patients admitted in a single tertiary care centre during a ten-year period. Patients were divided according to have at least one obstructive coronary artery (G1), defined by a stenosis above 50%, or not (G2) and baseline characteristics were compared between the two groups. All-cause mortality at 30 days and at 1 year were also compared using univariate Cox analysis. Results From 3765 ACS patients admitted during the study period, 461 (12.2%) were included in G2. G2 patients were older (62.6 ± 13.1 vs 66.2 ± 13.7; p &lt; 0.001) and more frequently women (26.3% vs 44.2%; p &lt; 0.001). Smoking was more frequent in G1 (40.0% vs 21.9%; p &lt; 0.001) but the prevalence of hypertension was higher in G2 (55.2% vs 64.2%; p &lt; 0.001). There were no differences regarding dyslipidaemia and diabetes. End-stage chronic kidney disease was higher in G2 (2.4% vs 4.1%; p = 0.025). Regarding the clinical evolution during hospitalization, G2 presented more frequently with Killip-Kimball class ≥II (13.9% vs 19.3%; p = 0.001), but at release there was no difference in the proportion of patients with left ventricular ejection fraction ≤50% (34.8% vs 32.1%; p = 0.286).  ACS with ST-segment elevation was more common in G1 (58.8% vs 52.1%; p = 0.006), but no differences were found regarding left and right bundle branch block patterns at presentation. In-hospital and 30-day mortality was not significantly different between groups (5.9% vs 7.4%; p = 0.205). However, at 1-year follow-up, G2 had a worse outcome regarding total mortality (HR (95%CI); 1.473 (1.103-1.969); p = 0.008, figure 1). Conclusion MINOCA patients seem not to be a low-risk group of ACS patients, since in this study they had a higher 1-year mortality than ACS patients with obstructive coronary disease. This higher mortality only became apparent after 30 days from the ACS. A systematic diagnostic work-up for further implementation of the most appropriate treatment should be crucial for getting better outcomes with this group of patients. Abstract Figure.

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