scholarly journals Atypical Presentation of Acute Myocardial Infarction

2021 ◽  
Vol 22 (2) ◽  
pp. 88-94
Author(s):  
Mohammad Shamsuddoha Sarker Shanchay ◽  
Farhana Sultana ◽  
Aysha Begum ◽  
Md Titu Miah
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Hospital Mortality ◽  
Clinical Feature ◽  
Atypical Presentation ◽  
College Hospital ◽  
Atypical Symptoms ◽  
Number Of Patients ◽  
Atypical Presentations

Introduction: Chest pain has been reported as the cardinal clinical feature of Acute Myocardial Infarction (AMI). However, a substantial number of patients may have atypical or no symptoms on initial evaluation. The absence of typical chest pain and the vagueness of symptoms might result in a delay in seeking medical care. In this study atypical presentations of AMI and in-hospital mortality and outcome were evaluated. Material and Methods: A hospital based cross sectional study was performed among 110 patients of AMI admitted in the CCU who fulfilled the inclusion criteria. The Study was done from July, 2013 to January, 2014 in Dhaka Medical College Hospital, Dhaka, and National Institute of Cardiovascular Diseases (NICVD), Dhaka. Results: Among the 110 patients with AMI, 22 (20%) patients presented with atypical presentation. The maximum incidence of AMI with atypical presentations was in the age group of 65-74 years (28.57%). Dyspnoea (36.36%) was the most among the atypical symptom followed by vomiting 22.72% and the least incident with vertigo 4.54%. Inferior MI being the highest 46% among atypical MI where as mortality rate was high among the antero-septal MI (22.86%). The in hospital mortality of myocardial infarction patients who presented with typical and atypical symptoms were 15% and 36.36 %. Conclusion: The patients without chest pain represent a substantial segment of the MI population. Older patients presented with more atypical symptoms with breathlessness being the commonest atypical symptoms. Mortality was high among the patients who presented with atypical symptoms, increasing age, and who presented lately. J MEDICINE 2021; 22: 88-94

scholarly journals Clinical presentation, risk factors, complications and outcome of acute myocardial infarction in elderly patients

2017 ◽  
Vol 5 (11) ◽  
pp. 4765 ◽  
Author(s):  
Sandhya S. ◽  
Mohanraj P.
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Elderly Patients ◽  
Epigastric Pain ◽  
Tertiary Care ◽  
Care Hospital ◽  
Wide Range ◽  
Atypical Presentations

Background: Myocardial Infarction is one of the most common causes of mortality and morbidity among the elderly patients. Also, it is known for wide range of clinical presentations other than chest pain. This article enlightens the clinical features, risk factors, complications, prognosis and outcome of Acute myocardial infarction in elderly patients. The objective of this study was to assess the risk factors, various symptoms, complications, prognosis and outcome of elderly patients with Acute myocardial Infarction (AMI).  Methods: This is a prospective study done over a period of two years in a tertiary care hospital in South India. 80 elderly patients who were diagnosed as AMI were included in the study.Results: Among the eighty patients the majority of the patients belonged to the age group 60-69 years. Twenty percent of the patients presented without chest pain. The atypical presentations included dyspnoea, giddiness, vomiting, sweating and epigastric pain. Mortality rate was 20%.Conclusions: This study showed that even though chest pain was the most common presentation in elderly AMI patients, they were also found to have atypical presentations like shortness of breath, giddiness, vomiting, sweating and epigastric pain. This signifies the need of examining physicians to meticulously identify acute myocardial infarction in elderly though they may not present typically.  

scholarly journals Outcome of Patients Having Acute Myocardial Infarction with and without Streptokinase

2019 ◽  
Vol 31 (2) ◽  
pp. 68-71
Author(s):  
Faruque Uddin ◽  
AK Fazlul Hoque
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Time Of Arrival ◽  
College Hospital ◽  
Medical College ◽  
North East ◽  
Acute Mi ◽  
Medicine Today ◽  
Mean Time

Introduction: Acute myocardial infarction is the leading cause of death. Streptokinase is the most commonly used thrombolytic agent. This study was conducted to compare in-hospital outcome of patients with acute myocardial infarction receiving streptokinase with those not receiving it. Materials & Methods: This descriptive observational study was conducted at Coronary Care Unit, North East Medical College Hospital from 1st July August 2016 to 30th June 2018. 340 patients having acute MI were in- cluded in the study. Two groups were formed: sk group receiving streptokinase and non-sk group not receiving. In-hospital mortality was the primary end point while mechanical and electrical complications were the secondary end points. Results: Among 340 patients, 255(75%) were males and 85(25%) females. Out of those 218 received strep-tokinase, while 122 did not. Mean age of sk group was 53.15±10.30 years and non-sk group 60.5±16 ears. Mean time of arrival to the hospital after symptom onset was 10.41±9.97 hours. SK group patients reached in 5.9±4.76 hours while non-sk group in 19.4±10.5 hours. In-hospital mortality in sk and non-sk group was 19(8.7%) and 25(20.5%) respectively, p=0.002. Complication rate was significantly higher in the non-sk group, 54.09% vs 34.86%, p=0.04. Conclusion: Patients of acute myocardial infarction receiving streptokinase have significantly lesser in-hospital mortality and complications as compared to patients not receiving it. Medicine Today 2019 Vol.31(2): 68-71

scholarly journals Machine-learning to Improve Prediction of Mortality following Acute Myocardial Infarction: An Assessment in the NCDR-Chest Pain-Myocardial Infarction Registry

2019 ◽  
Author(s):  
Rohan Khera ◽  
Julian Haimovich ◽  
Nate Hurley ◽  
Robert McNamara ◽  
John A Spertus ◽  
...  
Keyword(s):  
Machine Learning ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Logistic Regression ◽  
Chest Pain ◽  
High Risk ◽  
Hospital Mortality ◽  
Gradient Descent ◽  
Machine Learning Methods ◽  
C Statistic

ABSTRACTIntroductionAccurate prediction of risk of death following acute myocardial infarction (AMI) can guide the triage of care services and shared decision-making. Contemporary machine-learning may improve risk-prediction by identifying complex relationships between predictors and outcomes.Methods and ResultsWe studied 993,905 patients in the American College of Cardiology Chest Pain-MI Registry hospitalized with AMI (mean age 64 ± 13 years, 34% women) between January 2011 and December 2016. We developed and validated three machine learning models to predict in-hospital mortality and compared the performance characteristics with a logistic regression model. In an independent validation cohort, we compared logistic regression with lasso regularization (c-statistic, 0.891 [95% CI, 0.890-0.892]), gradient descent boosting (c-statistic, 0.902 [0.901-0.903]), and meta-classification that combined gradient descent boosting with a neural network (c-statistic, 0.904 [0.903-0.905]) with traditional logistic regression (c-statistic, 0.882 [0.881-0.883]). There were improvements in classification of individuals across the spectrum of patient risk with each of the three methods; the meta-classifier model – our best performing model - reclassified 20.9% of individuals deemed high-risk for mortality in logistic regression appropriately as low-to-moderate risk, and 8.2% of deemed low-risk to moderate-to-high risk based consistent with the actual event rates.ConclusionsMachine-learning methods improved the prediction of in-hospital mortality for AMI compared with logistic regression. Machine learning methods enhance the utility of risk models developed using traditional statistical approaches through additional exploration of the relationship between variables and outcomes.

scholarly journals Symptom presentation of acute myocardial infarction – can we correctly identify patients with atypical symptoms of myocardial infarctions over the phone?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.L Moeller ◽  
E.H.A Mills ◽  
F Gnesin ◽  
N Zylyftari ◽  
F Folke ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Early Recognition ◽  
High Risk Patient ◽  
Funding Source ◽  
Symptom Presentation ◽  
Atypical Symptoms ◽  
Risk Of Death ◽  
Emergency Ambulance

Abstract Introduction Acute myocardial infarction (AMI) can manifest itself with a variety of symptoms which can hinder early recognition of the disease, particularly when diagnosis is performed over the phone. It is currently unknown to what extent AMI patients are correctly recognized and quickly referred to treatment when calling for help at the emergency medical services (EMS) and out-of-hours service (OOHS). Therefore, we investigated how the symptom presentation of AMI patients affected their chances of being recognized. Purpose This study aimed to describe the symptoms reported by AMI patients when calling the EMS and OOHS and investigate to what extent these patients were correctly recognized and lastly, how the symptom presentation affected the survival. Methods All calls to the EMS and OOHS in the Capital Region of Denmark from 1st January 2014 to 31st December 2017 are included in this study resulting in 4,905,318 calls made by 1,313,980 people. A total of 5,526 people were identified with either a hospital admission with an AMI or an AMI as cause of death maximum 72 hours after a call to the EMS or OOHS. The main symptoms were registered by the EMS and OOHS personnel and we grouped the symptoms into symptom categories. Finally, a patient was defined as recognized if an emergency ambulance were dispatched. The unrecognized patients were separated into one group which were not referred to any treatment and another group that received none-urgent treatment. Results 72% of all AMI patients reported chest pain as their main symptom followed by breathing problems (7%) and unknown problems (5%). A total of 76% of all AMI patients were correctly recognized and received an emergency ambulance. The proportion of recognized AMIs was 88% at the EMS, but only 55% at the OOHS. The symptom presentation was highly associated with the help provided to the patient and less than 14% of patients reporting musculoskeletal pain, infection/fever or pain in stomach/back/intestine received an emergency ambulance. In comparison, 87% of patients with chest pain and 96% of unconscious patients received an emergency ambulance (Figure 1). Results from a multiple logistic regression showed that chest pain patients had the lowest risk of death at 30-days follow-up compared to all other symptom presentation. Conclusion 24% of AMI patients were not correctly recognized with an acute life-threatening disease when calling for help. Patients presenting without chest pain and unconsciousness had a much lower chance of being recognized. Similarly, patients calling the OOHS were less likely to be recognized compared to patients calling the EMS. Symptom presentations without chest pain had a dramatically increased 30-day mortality indicating that AMI patients with atypical symptoms truly are a high-risk patient group. Figure 1 Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The Danish Heart Association

scholarly journals Assessment of the CHA2DS2-VASc score in predicting ischemic stroke and death in patients with acute myocardial infarction without atrial fibrillation

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Marques ◽  
A Briosa ◽  
AR Pereira ◽  
S Alegria ◽  
J Grade Santos ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Ischemic Stroke ◽  
Chest Pain ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Rank Test ◽  
Log Rank Test ◽  
Previous Therapy

Abstract Funding Acknowledgements Type of funding sources: None. onbehalf on behalf of the investigators of the Portuguese Registry of Acute Coronary Syndromes Introduction The CHA2DS2-VASc score is used in clinical practice to stratify the risk of stroke in patients (pts) with atrial fibrillation (AF). Its usefulness in the population of pts with acute myocardial infarction without AF is not well known. Objectives To investigate whether CHA2DS2-VASc predicts ischemic stroke and death during hospital stay in pts with acute myocardial infarction without known AF. To determine independent predictors of ischemic stroke in this population. Methods A multicentre, retrospective study was performed during 01/10/2010-04/09/2019 period, and included all pts admitted due to acute myocardial infarction. Pts with previous AF, AF rhythm in the electrocardiogram at admission or AF during hospital stay were excluded. Statistical analysis with Kaplan-Mayer and Cox regression was applied. Results Of 29851 pts admitted with acute myocardial infarction, were included in our study 19218 pts (74% male, mean age of 65 ± 14 years).  During hospital stay, 78 (0.4%) pts had an ischemic stroke and 462 (2.4%) pts died.  The event-free survival analysis showed significant differences according to the CHA2DS2-VASc score at admission (log rank test p = 0.015 for ischemic stroke; log rank test p < 0.001 for in-hospital mortality). (Figure)  The CHA2DS2-VASc score demonstrated a good predictive accuracy for in-hospital mortality (area under the ROC curve 0.69; 95% CI 0.67-0.72; p < 0.001). The area under the ROC curve indicates that the CHA2DS2-VASc score performed modestly for ischemic stroke (0.62; 95% CI 0.56-0.68; p < 0.001).  In univariate analysis, the factors that were positively associated with ischemic stroke during hospital stay were CHA2DS2-VASc, absence of previous therapy with statin, time between cardiac symptoms and hospital admission, absence of chest pain, Killip-Kimball class, cardiorespiratory arrest, complete left ventricular block and left ventricle ejection fraction <50% (p < 0.05).  After multivariate analysis, CHA2DS2-VASc≥3 (HR 2.25; 95% CI 1.37-3.71; p = 0.001), absence of chest pain (HR 3.17; CI 1.44-6.14, p < 0.001) and previous therapy with statin (HR 0.39; 95% CI 0.22-0.67; p = 0.001) were independent predictors of ischemic stroke. Conclusion  Among patients with acute myocardial infarction without known atrial fibrillation, the CHA2DS2-VASc score was associated with risk of ischemic stroke and death during hospital stay. This score may be useful for estimating the risk of stroke and in-hospital mortality in these population without known atrial fibrillation. Abstract Figure.

scholarly journals Changes in clinical features and outcomes in three major critical diseases after COVID-19 pandemic: acute myocardial infarction, stroke, and cardiac arrest

2021 ◽  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Arrest ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Hemorrhagic Stroke ◽  
Moving Average ◽  
Multivariable Logistic Regression Analysis ◽  
Number Of Patients ◽  
Post Period

A few months after the onset of the coronavirus Disease 2019 (COVID-19) pandemic, the worse prognoses of acute myocardial infarction, ischemic and hemorrhagic stroke, and cardiac arrest were reported. This study aimed to investigate the changes in the characteristics and prognoses of these diseases in the emergency department (ED) over a year after pandemic’s onset. This was a retrospective observational study. The year 2019 was defined as the pre-period, while the year from February 2020 to January 2021 was defined as the post-period. Adult patients diagnosed with acute myocardial infarction, ischemic stroke, hemorrhagic stroke, or cardiac arrest during the study period were included. The primary outcome was in-hospital mortality. Time series analyses using autoregressive integrated moving average (ARIMA)(p,d,q) model were performed to evaluate the changes between periods. A multivariable logistic regression analysis of factors affecting in-hospital mortality was performed. The proportions of patients with acute myocardial infarction (0.8% vs. 1.1%, p < 0.001), hemorrhagic stroke (1.0%vs. 1.2%, p = 0.011), and cardiac arrest (0.9% vs. 1.1%, p = 0.012) increased in the post-period. The post-period was independently associated with in-hospital mortality in acute myocardial infarction (adjusted odds ratio (aOR) 2.54, 95% confidence interval (95% CI) 1.06–6.08, p = 0.037) and hemorrhagic stroke (aOR 1.74, 95% CI 1.11–2.73, p = 0.016), but not for ischemic stroke or cardiac arrest. Over a year after onset of the COVID-19 pandemic in Korea, the number of patients with acute myocardial infarction, hemorrhagic stroke, and cardiac arrest in the ED increased. An independent association between the post-period and mortality was observed for acute myocardial infarction, and hemorrhagic stroke. This study provides important information for future studies and policies.

scholarly journals Study on Seasonal Variation of Acute Myocardial Infarction Hospitalization

2020 ◽  
Vol 12 (2) ◽  
pp. 126-134
Author(s):  
Md Sajjadur Rahman ◽  
Abdul Wadud Chowdhury ◽  
Khandker Md Nurus Sabah ◽  
Md Gaffar Amin ◽  
Sudhakar Sarker ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Seasonal Variation ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Public Health Issue ◽  
P Value ◽  
College Hospital ◽  
Post Monsoon ◽  
Number Of Patients

Background: Coronary artery disease is an important medical and public health issue as it is common and leading cause of mortality and morbidity in Bangladesh as it is throughout the world. This study was carried out to determine the existence of seasonal rhythms in hospital admissions due to acute myocardial infarction (AMI) in Dhaka Medical College Hospital. Methods: This cross-sectional observational study was conducted during the period of April 2015 to March 2016 among the patients with AMI admitted at the Cardiology Department of DMCH. 882 patients were enrolled. Results: The highest number of patients were admitted during winter (n=285, 32.3%) followed by post monsoon (n=213, 24.1%) and monsoon (n=194, 22.0%). The lowest number of patients were admitted during summer (n=190, 21.5%). The hospital admission was significantly higher in winter compared to other seasons (p-value versus summer, monsoon and post monsoon was 0.008, 0.011 and 0.042 respectively). Conclusion: A seasonal variation in the hospital admission due to AMI with a peak in winter was clearly demonstrated in the study. Persons admitted to hospital with AMI tend to be all age groups and both sexes present a stronger seasonal variation peak admission in winter. Cardiovasc. j. 2020; 12(2): 126-134

THROMBOLYTIC THERAPY IN ACUTE MYOCARDIAL INFARCTION: THE SCOPE IN A DISTRICT GENERAL HOSPITAL

1987 ◽  
Author(s):  
R G Murray ◽  
J Jagger ◽  
M K Davies ◽  
W A Littler
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Thrombolytic Therapy ◽  
General Hospital ◽  
District General Hospital ◽  
Peptic Ulcers ◽  
Hospital Data ◽  
Number Of Patients ◽  
Recent Acute Myocardial Infarction

Despite the interest in thrombolytic therapy in acute’ myocardial infarction, it has been reported.that only a small minority of patients considered for thrombloysis would be suitable. .To determine the demand for such therapy in a District General Hospital, data were collected for patients admitted with chest pain to our Coronary Care Unit over a six month period. Of 197 patients admitted with chest pain 131 patients (67%) were proven to have acute myocardial infarction. Criteria for thrombolytic therapy included presentation within six hours of the onset of symptoms, ST elevation ≥ 0.2 mV in 2 or more ECG leads and age ≤ 70 years. Sixty-seven (51%) of the 131 patients with subsequently proven acute myocardial infarction were eligible for thrombolysis. Criteria for thrombolysis were not fulfilled in 41 patients with acute myocardial infarction; 17 (13%) presented later than six hours, 15 (12%) failed to meet the ECG criteria and 9 (7%) were over 70 years. A further 12 (9%) patients were excluded for cardiogenic shock, patients had peptic ulcers, one patient sustained a recent acute myocardial infarction 2 weeks previously and data from 8 patients were lost.These results suggest that around 50% of patients with acute myocardial infarction and 34% of all patients presenting with chest pain would be suitable for thrombolytic therapy. These data do not support the view that such treatment may only be applicable to a small number of patients with acute myocardial infarction.

scholarly journals Incidence of cardiac arrhythmias in patients with acute myocardial infarction during the first 48 hours of the onset of chest pain

2017 ◽  
Vol 4 (4) ◽  
pp. 1144
Author(s):  
Puneet Rajendra Patil ◽  
Pankaj Khatana ◽  
Dilip Ratan Patil
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Cardiac Arrhythmia ◽  
Cardiac Arrhythmias ◽  
Anterior Wall ◽  
Age Group ◽  
Eligible Study ◽  
Number Of Patients ◽  
Acute Mi

Background: It is predicted that there will be an increase of 111% in cardiovascular deaths in India by the year 2020 compared to the year 1990. This is much higher than that predicted in any other region both in Asia as well as outside Asia. The objective of this study was to study the incidence of cardiac arrhythmias in acute myocardial infarction during the first 48 hours.Methods: The descriptive study was conducted over a period of two years from April 2016 to January 2017. A total of 102 patients were studied. They were admitted to ICU. Their admission was done as soon as they had chest pain. They were first confirmed to have acute myocardial infarction. All eligible study subjects as per inclusion and exclusion criteria were considered in the present study. Detailed history was taken. A thorough physical examination was done with emphasis on the cardiovascular system.Results: Maximum number of patients was in the age group 51-60 years in both males (37.97%) and females (65.22%). Acute MI observed mostly in the postmenopausal age in all the females. Incidence of myocardial infarction was significantly more in men (77.50%) compared to women (22.50%). 52.90% were smokers. Almost half of the patients had shown anterior wall infarction. The incidence of cardiac arrhythmias was 78.70%. Arrhythmias were more common among elderly female. Maximum arrhythmias were observed in the age group ranging from 50 to 60 years (36.27%).Conclusions: The incidence of cardiac arrhythmia was found to be 78.7% in the present study. The incidence of cardiac arrhythmia was more in the age group 50-60 years (36.27%).

scholarly journals Role of telemedicine network provided by pharmacies to detect acute myocardial infarction in patients with chest pain during coronavirus pandemia

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
F Fioretti ◽  
M Piazzani ◽  
D S Cani ◽  
A Madureri ◽  
G F Gensini ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Hospital Admissions ◽  
Public Institution ◽  
Lombardy Region ◽  
Outbreak Period ◽  
Italian Regions ◽  
Number Of Patients ◽  
The Impact

Abstract Background During the lockdown period in Italy, from March 11th to May 4th 2020, a progressive increase in COVID-19 cases occurred in all Italian regions, in particular in the Lombardy Region. The current rise in COVID-19 cases has led to an increasing involvement of hospitals, in order to face the Coronavirus outbreak, shifting healthcare resources towards the management of COVID+ patients. This has led, on the other hand, to a progressive decrease in hospital admissions due to conditions not associated with SARS-CoV2 infection. During COVID-19 outbreak period, it has been observed a decrease in hospital admissions for acute myocardial infarction. This phenomenon put in serious difficulty the clinical management of COVID-free patients with cardiovascular disease, at the beginning of phase 2 (starting from May 4 2020). Purpose In this scenario, we aimed to verify the impact of telemedicine during lockdown, in comparison with the same period in 2019. Materials and method We analyzed 12-lead ECGs recorded by 5000 country pharmacies, evaluated and stored in one telemedicine platform provided by Health Telematic Network (HTN), in cooperation with our Cardiology Department, Federfarma (Pharmacists' National Association), and Italian National Health Institute. Results During the lockdown period, were recorded 6,104 ECGs in territorial pharmacies, compared to 17,280 ECGs done in the same period in 2019. Chest pain symptom represented the cause of recording ECG in 298 patients (4.88%) during the lockdown period, compared to 402 patients (2.33%) in the same period in 2019, with an increase of 109.86%. In the Lombardy Region, during lockdown period, were reported 118 accesses to territorial pharmacies for chest pain (about 39.50% of total cases in Italy). Among these, 36 accesses were in the province of Brescia (about 30.50%), whereas 28 of them were in the province of Bergamo (about 23.73%). Among ECGs performed, 8 showed typical abnormalities of acute myocardial infarction with ST elevation (STEMI, 2.68%) in the lockdown period, compared to 7 STEMIs (1.74%) detected in the same period in 2019, with an increase of 54.17%. These patients were referred to Emergency Department (ED) suddenly, for the therapeutic intervention. Conclusion These data shown that a large number of patients with cardiovascular symptoms preferred to go to territorial pharmacies rather than hospitals during the COVID outbreak period. Telemedicine played a prominent role in managing patients with cardiovascular symptoms at home. Moreover, this service allowed patients with STEMI to access to the hospitals faster, avoiding the risks of a serious diagnostic delay. Furthermore, by analyzing the data of Lombardy Region, it was possible to show how a significant component of access to local pharmacies for chest pain occurred in the region most affected by the COVID-19 outbreak. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): University of Brescia Number of ECGs recorded for chest pain Data recorded in Lombardy Region

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