Myocardial Infarction Signs and Symptoms: Females vs. Males

Detecting cardiac injury: the next generation of high-sensitivity cardiac troponins improving diagnostic outcomes

Cardiac injury, encompassing a spectrum of heart muscle damage, requires prompt and accurate diagnosis to improve patient outcomes. Early detection using cardiac biomarkers is vital for timely intervention and reducing mortality. This review highlights the role of high-sensitivity cardiac troponins (hs-cTns) in diagnosing cardiac injury. This article offers an overview of cardiac injury, including its causes, diagnostic challenges, and the evolution of biomarkers, up to the development and commercialization of "high-sensitivity" (hs-) cTns. The molecular structure of cardiac isoforms cTnI and cTnT, release kinetics, guidelines incorporation, diagnostic performance, and clinical application will be analyzed. It is concluded that the advent of hs-cTn assays has further expanded diagnostic capabilities by enabling the detection of low-level cTn elevations, which were previously undetectable using conventional methods. This enhanced sensitivity allows earlier identification of even minor cardiac injuries, facilitating prompt intervention and improving patient outcomes. However, this increased sensitivity also introduces interpretive challenges in understanding the nature of cardiac involvement, especially in distinguishing mild cTn elevations that may signify non-ischemic cardiac injury or be associated with other non-cardiac conditions.

Prodromal Symptoms of Acute Myocardial Infarction in Women: A Systematic Review of Current Evidence

AIM

To synthezise quantitative current evidence on the prodromal symptoms experienced by women before the onset of acute coronary syndrome (ACS), focusing on the prevalence, nature and clinical implications of these symptoms.

DESIGN

A systematic review.

METHODS

The review adhered to Synthesis without meta-analysis guidelines and was registered with the PROSPERO database (ID: CRD42024541840). Systematic searches were conducted in PubMed, CINAHL, APA PsycArticles, APA PsycInfo and EMBASE. Included studies were quantitative, focused on women aged ≥ 18 years with confirmed acute coronary syndrome and reported prodromal symptoms. The Quality Assessment with Diverse Studies and the Cochrane Risk of Bias in non-randomized studies of Interventions tools were used for critical appraisal.

RESULTS

Of 2170 identified records, 11 full-text studies were reviewed. The most frequently reported prodromal symptom was unusual fatigue, followed by sleep disturbances and anxiety. Prodromal symptoms often occurred well before the acute event but were frequently misattributed to non-cardiac causes. Chest pain, typically associated with acute coronary syndrome, was less commonly reported as a prodromal symptom in women, complicating timely diagnosis and treatment.

CONCLUSIONS

The results highlight the need for increased awareness of these early warning signs among healthcare providers and women themselves. Enhanced recognition and understanding of these symptoms could lead to more timely and accurate diagnosis, ultimately improving outcomes for women at risk of acute myocardial infarction.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

To educate both health professionals and patients about the variability and significance of prodromal symptoms in women is essential to improve outcomes.

IMPACT

This study is the first to systematically review and synthesize the existing literature on prodromal symptoms of acute coronary syndrome specifically in women. The results show l that women are more likely to experience a broader and more complex range of prodromal symptoms, including fatigue, sleep disturbances and anticipatory anxiety, which often precede the acute event. The insights provided by our review could lead to significant improvements in the early diagnosis and treatment of AMI in women, ultimately reducing morbidity and mortality rates associated with cardiovascular diseases.

REPORTING METHOD

The review has adhered to relevant EQUATOR guidelines and has followed Synthesis without meta-analysis guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Atypical Symptoms on Admission Predict Progression to Heart Failure in Patients With First-Time Myocardial Infarction: Using Data From the Korean Multicenter Cohort Registry

BACKGROUND

Identifying the initial factors predicting heart failure (HF) progression in patients with myocardial infarction (MI), a major cause of HF, is essential.

OBJECTIVES

We aimed to examine predictors of rehospitalization due to HF in patients with first-time MI from the Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH) prospective cohort between 2011 and 2015.

METHODS

A secondary data analysis was conducted on a population of 8888 patients who completed 3 years of follow-up and had no history of MI, HF, or death. The HF group was defined as patients rehospitalized with an HF diagnosis due to worsening symptoms. A 1:4 propensity score matching analysis was performed on 11 baseline characteristics, and the clinical conditions and complications of the HF group (n = 252) were compared with the non-HF group (n = 991). Statistical analyses were performed using SAS version 9.4 and R version 4.2.3.

RESULTS

A Cox proportional hazards model showed that the factors predicting rehospitalization due to HF were dyspnea (HR, 1.54; 95% CI, 1.16-2.04; P = .003), left ventricular ejection fraction <50% (HR, 2.71; 95% CI, 2.06-3.58; P < .001), and new-onset HF confirmed during hospitalization (HR, 1.77; 95% CI, 1.18-2.66; P = .006). Atypical chest pain (no chest pain) was significant only in univariate analysis.

CONCLUSIONS

This study highlights the importance of carefully monitoring symptoms and conditions during outpatient follow-up in post-MI patients, regardless of age, sex, or medical history. In particular, those who present with dyspnea at admission or develop new-onset HF during hospitalization should be considered high-risk for HF rehospitalization.

In-hospital outcomes of patients with ST-segment elevation myocardial infarction with and without obstructive sleep apnea: a nationwide propensity score-matched analysis

INTRODUCTION

Obstructive Sleep Apnea (OSA) is a prevalent condition affecting millions worldwide and is associated with an increased risk of cardiovascular complications, including ST-Elevation Myocardial Infarction (STEMI). The relationship between OSA and STEMI is complex, with OSA potentially exacerbating the severity of coronary artery disease and influencing outcomes following acute coronary events.

METHODS

We retrospectively analyzed data from the National Inpatient Sample database from 2016 to 2021. Hospitalized patients aged 18 and older diagnosed with STEMI were included. Key outcomes, such as in-hospital mortality, cardiac interventions and inpatient complications, were compared between those with and without OSA. Propensity score matching was utilized to account for potential confounders and risk of complications was compared.

RESULTS

Among 1,203,915 STEMI hospitalizations, 75,035 (6.2%) had OSA. After PSM, OSA was associated with lower in-hospital mortality (aOR: 0.82, 95% CI: 0.76-0.89, p < 0.001) but higher risks of atrial fibrillation (aOR: 1.28, 95% CI: 1.21-1.36, p < 0.001), venous thromboembolism (aOR: 1.23, 95% CI: 1.06-1.44, p = 0.009), acute kidney injury (aOR: 1.10, 95% CI: 1.04-1.16, p = 0.001), and second-degree atrioventricular block (aOR: 1.69, 95% CI: 1.33-2.15, p < 0.001). OSA patients were more likely to require non-invasive ventilation (aOR: 2.78, 95% CI: 2.48-3.11, p < 0.001) but less likely to need invasive ventilation (aOR: 0.91, 95% CI: 0.84-0.96, p < 0.001) or vasopressors (aOR: 0.77, 95% CI: 0.68-0.87, p = 0.001). Female STEMI patients with OSA had higher mortality than males (aOR: 1.17, 95% CI: 1.14-1.20, p < 0.001) and underwent fewer invasive interventions.

CONCLUSION

OSA in STEMI patients was associated with lower in-hospital mortality but a higher burden of complications, emphasizing the need for proactive risk stratification. The increased reliance on non-invasive ventilation highlights distinct management patterns. Additionally, the significant sex disparity, with higher mortality and fewer interventions in women, underscores the need for tailored, evidence-based strategies.

Factor XIII-A Transglutaminase Contributes to Neutrophil Extracellular Trap (NET)-mediated Fibrin(ogen) Network Formation and Crosslinking

BACKGROUND

 Neutrophil extracellular traps can contribute to thrombosis via stabilization of fibrin network, which is normally conducted by plasma transglutaminase, Factor XIII-A as part of coagulation cascade. The possible presence and activity of FXIII-A in neutrophils or during NETosis are unknown. Here, we investigated potential presence of FXIII-A in neutrophils and participation in NET-fibrin(ogen) interaction in vitro. METHODS:  Data mining of human and mouse F13A1/F13a1 mRNA expression in whole-body scRNA sequence atlases was conducted. F13a1 mRNA and protein expression was assessed in isolated mouse bone marrow neutrophils. NETosis was induced using 12-phorbol 13-myristate acetate (PMA), and the transglutaminase activity was assessed with 5-(biotinamido)pentylamine incorporation to plasma fibronectin and a fluorescence-fibrin(ogen)-based activity assay using ATTO488-Cadaverine. Externalization of FXIII-A and its interaction with neutrophil extracellular trap (NET) markers, namely, decondensed DNA, CitH3, and MPO, were examined with immunofluorescence microscopy. NET-fibrin(ogen) interaction was investigated with and without serum and/or transglutaminase inhibitor, NC9. Effect of soluble fibrinogen and fibrin(ogen) network on NETosis was also assessed.

RESULTS

 Data mining of RNAseq atlases showed F13A1/F13a1 expression in adipose tissue, blood, and bone marrow neutrophils. mRNA expression and protein production were confirmed in isolated neutrophils where expression was comparable to that of macrophages and monocytes. FXIII-A was externalized and active as a transglutaminase and colocalized with NET markers during NETosis. FXIII-A transglutaminase activity promoted NET-fibrin(ogen) interaction and entrapment of neutrophils within fibrin(ogen) matrix. Soluble fibrinogen or fibrin(ogen) network did not induce NETosis.

CONCLUSION

 This study identifies neutrophils as a source of FXIII-A and suggests its role in stabilizing NET-fibrin(ogen) matrix structures.

A semi-empirical Bayes approach for calibrating weak instrumental bias in sex-specific Mendelian randomization studies

Strong sex differences exist in sleep phenotypes and also cardiovascular diseases (CVDs). However, sex-specific causal effects of sleep phenotypes on CVD-related outcomes have not been thoroughly examined. Mendelian randomization (MR) analysis is a useful approach for estimating the causal effect of a risk factor on an outcome of interest when interventional studies are not available. We first conducted sex-specific genome-wide association studies (GWASs) for suboptimal-sleep phenotypes (insomnia, obstructive sleep apnea (OSA), short and long sleep durations, and excessive daytime sleepiness) utilizing the Million Veteran Program (MVP) dataset. We then developed a semi-empirical Bayesian framework that (i) calibrates variant-phenotype effect estimates by leveraging information across sex groups, and (ii) applies shrinkage sex-specific effect estimates in MR analysis, to alleviate weak instrumental bias when sex groups are analyzed in isolation. Simulation studies demonstrate that the causal effect estimates derived from our framework are substantially more efficient than those obtained through conventional methods. We estimated the causal effects of sleep phenotypes on CVD-related outcomes using sex-specific GWAS data from the MVP and All of Us. Significant sex differences in causal effects were observed, particularly between OSA and chronic kidney disease, as well as long sleep duration on several CVD-related outcomes. By applying shrinkage estimates for instrumental variable selection, we identified multiple sex-specific significant causal relationships between OSA and CVD-related phenotypes.

2024 American Heart Association and American Red Cross Guidelines for First Aid

Codeveloped by the American Heart Association and the American Red Cross, these guidelines represent the first comprehensive update of first aid treatment recommendations since 2010. Incorporating the results of structured evidence reviews from the International Liaison Committee on Resuscitation, these guidelines cover first aid treatment for critical and common medical, traumatic, environmental, and toxicological conditions. This update emphasizes the continuous evolution of evidence evaluation and the necessity of adapting educational strategies to local needs and diverse community demographics. Existing guidelines remain relevant unless specifically updated in this publication. Key topics that are new, are substantially revised, or have significant new literature include opioid overdose, bleeding control, open chest wounds, spinal motion restriction, hypothermia, frostbite, presyncope, anaphylaxis, snakebite, oxygen administration, and the use of pulse oximetry in first aid, with the inclusion of pediatric-specific guidance as warranted.

The Relationship Between the Type of ST-Segment Elevation in Acute Anterior Wall Myocardial Infarction and Left Ventricular Ejection Function

INTRODUCTION

Acute anterior wall myocardial infarction (AWMI), when presenting with ST-segment elevation on an electrocardiogram (ECG), represents a form of ST-elevation myocardial infarction (STEMI) caused by a significant reduction in coronary blood flow to the heart muscle. The shape of the ST-segment elevation, whether it is concave, convex, or straight, has been associated with different levels of left ventricular ejection fraction (LVEF), which is an important indicator of cardiac function and prognosis.

OBJECTIVE

To investigate the relationship between the type of ST-segment elevation on ECG and LVEF measured 48 hours after the onset of myocardial infarction in patients with AWMI.

METHODOLOGY

A retrospective observational study was conducted on 317 patients with acute anterior wall myocardial infarction at Shalamar Hospital, Lahore, Pakistan, from January 2023 to December 2023. Patients' electrocardiograms were analyzed for ST-segment elevation morphology, and left ventricular ejection fraction was assessed using echocardiography. Long-term echocardiography was performed at 30 days and 90 days post-infarction to evaluate the long-term effects on LVEF and to assess for stunned or hibernating myocardium. Statistical analysis was performed in IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. to determine the association between ST-segment types and left ventricular ejection fraction.

RESULTS

The mean age was 58.3 ± 12.4 years, with a majority being male (67.5%). Key findings included that 33.1% of patients had left ventricular ejection fraction (LVEF) < 40%, while the mean LVEF was 45.2 ± 9.8%. Primary percutaneous coronary intervention (PCI) was performed in 45.7% of patients, and no deaths occurred during hospitalization. A significant association was observed between the type of ST-segment elevation and LVEF, with convex ST elevation linked to a 2.7-fold increased likelihood of severe LV dysfunction (LVEF < 40%) and a hazard ratio of 2.3 for adverse outcomes (p = 0.005). In contrast, concave ST elevation did not show significant predictive value for LV dysfunction. Older age and smoking were also identified as strong predictors of LV dysfunction, highlighting the impact of these factors on patient outcomes post-AWMI.

CONCLUSION

The study demonstrates a significant correlation between convex ST-segment elevation and lower LVEF, suggesting that ST-segment morphology can serve as an important prognostic indicator in AWMI patients.

Sex and 30-day survival following out-of-hospital cardiac arrest in Scotland 2011-2020

BACKGROUND

Differences in 30-day survival between males and females following out-of-hospital cardiac arrest (OHCA) are well documented. Biological sex does not appear to be responsible for this survival gap independently of potential mediating factors. We investigated the role of potential mediating factors in the association between sex and 30-day survival after OHCA in Scotland.

METHODS

A retrospective cohort study of adult non-emergency medical services (EMS)-witnessed OHCA cases was conducted. We included incidents from the whole of Scotland where resuscitation was attempted by the Scottish Ambulance Service (SAS) between April 1, 2011 and March 1, 2020. Logistic regression was used to assess the contribution of age, socioeconomic status, urban-rural location of the incident, initial cardiac rhythm, bystander cardiopulmonary resuscitation (CPR) and location of the arrest (home or away from home).

RESULTS

The cohort consisted of 20,585 OHCA cases (13,130 males and 7,455 females). Median (IQR) age was 69 years (22) for males versus 72 years (23) for females. A higher proportion of males presented with initial shockable rhythm (29.4% versus 12.4%) and received bystander CPR (56.7% versus 53.2%) compared with females. A higher proportion of females experienced OHCA at home (78.8% versus 66.8%). Thirty-day survival after OHCA was higher for males compared with females (8.2% versus 6.2%). Males had higher age-adjusted odds for 30-day survival after OHCA than females (OR, 1.26; (95% CI), 1.12-1.41). Mediation analyses suggested a role for initial cardiac rhythm and location of the arrest (home or away from home).

CONCLUSION

Males had higher age-adjusted 30-day survival after OHCA than females. However, after adjusting for confounding/mediating variables, sex was not associated with 30-day survival after OHCA. Our findings suggest that initial cardiac rhythm and location of the arrest are potential mediators of higher 30-day OHCA survival in males than females. Improving proportions of females who present with initial shockable rhythm may reduce sex differences in survival after OHCA.

Glutamine metabolism improves left ventricular function but not macrophage-mediated inflammation following myocardial infarction

Glutamine is a critical amino acid that serves as an energy source, building block, and signaling molecule for the heart tissue and the immune system. However, the role of glutamine metabolism in regulating cardiac remodeling following myocardial infarction (MI) is unknown. In this study, we show in adult male mice that glutamine metabolism is altered both in the remote (contractile) area and in infiltrating macrophages in the infarct area after permanent left anterior descending artery occlusion. We found that metabolites related to glutamine metabolism were differentially altered in macrophages at days 1, 3, and 7 after MI using untargeted metabolomics. Glutamine metabolism in live cells was increased after MI relative to no MI controls. Gene expression in the remote area of the heart indicated a loss of glutamine metabolism. Glutamine administration improved left ventricle (LV) function at days 1, 3, and 7 after MI, which was associated with improved contractile and metabolic gene expression. Conversely, administration of BPTES, a pharmacological inhibitor of glutaminase-1, worsened LV function after MI. Neither glutamine nor BPTES administration impacted gene expression or bioenergetics of macrophages isolated from the infarct area. Our results indicate that glutamine metabolism plays a critical role in maintaining LV contractile function following MI and that glutamine administration improves LV function. Glutamine metabolism may also play a role in regulating macrophage function, but macrophages are not responsive to exogenous pharmacological manipulation of glutamine metabolism.NEW & NOTEWORTHY Glutamine metabolism is altered in both infarct macrophages and the remote left ventricle (LV) following myocardial infarction (MI). Supplemental glutamine improves LV function following MI while inhibiting glutamine metabolism with BPTES worsens LV function. Supplemental glutamine or BPTES does not impact macrophage immunometabolic phenotypes after MI.

Impact of Sex in the Incidence of Heart Failure in Patients with Chronic Coronary Syndrome

PURPOSE OF REVIEW

This review examines the available evidence concerning the incidence of heart failure in patients with chronic coronary syndrome, with a focus on gender differences.

RECENT FINDINGS

The incidence of heart failure in the context of chronic coronary syndrome presents conflicting data. Most of the available information stems from studies involving stable patients' post-acute coronary syndrome, revealing a wide range of incidence rates, from less than 3% to over 20%, observed over 5 years of follow-up. Regarding the gender differences in heart failure incidence, there is no consensus about whether women exhibit a higher incidence, particularly in the presence of evidence of obstructive coronary artery disease. However, in cases where obstructive coronary artery disease is absent, women may face a more unfavourable prognosis due to a higher prevalence of microvascular disease and heart failure with preserved ventricular function. The different profile of ischaemic heart disease in women difficult to establish differences in prognosis independently associated with female sex. Targeted investigations are essential to discern the incidence of heart failure in chronic coronary syndrome and explore potential gender-specific associations.

Comparison of the Clinical Manifestations of Acute Coronary Syndrome Between Diabetic and Non-diabetic Patients: A Systematic Review and Meta-Analysis

The presentation of acute coronary syndrome (ACS) in patients with type 2 diabetes mellitus (T2DM) may differ from that of non-diabetic patients, potentially leading to delayed diagnosis and treatment. This meta-analysis aimed to compare the clinical presentation of ACS between diabetic and non-diabetic patients. A systematic search of PubMed, Excerpta Medica database (EMBASE), and Web of Science databases was conducted for observational studies published from January 2010 onwards. Studies comparing ACS symptoms between diabetic and non-diabetic patients were included. The odds ratio (OR) with 95% confidence intervals (CI) was calculated using a random-effects model. Eight studies with a total of 29,503 patients (23.03% diabetic) were included. Diabetic patients were significantly less likely to present with chest pain compared to non-diabetic patients (OR: 0.43, 95% CI: 0.30 to 0.63, p<0.001). Anxiety (OR: 2.20, 95% CI: 1.17-4.14), shortness of breath (OR: 1.49, 95% CI: 1.11-2.01), and neck pain (OR: 1.62, 95% CI: 1.03-2.54) were significantly more common in diabetic patients. Sweating/cold sweat was less common in diabetics (OR: 0.60, 95% CI: 0.34-1.07), though not statistically significant. Other symptoms showed minimal differences between groups. High heterogeneity was observed across studies for most symptoms. This meta-analysis demonstrates that diabetic patients with ACS are less likely to experience typical chest pain and more likely to present with atypical symptoms such as anxiety, shortness of breath, and neck pain. These findings emphasize the need for healthcare providers to maintain high vigilance for atypical ACS presentations in diabetic patients. Tailored diagnostic approaches, modified triage protocols, and enhanced patient education are crucial to improving the timely diagnosis and treatment of ACS in this high-risk population.

Exploring the effects of real-time online cardiac telerehabilitation using wearable devices compared to gym-based cardiac exercise in people with a recent myocardial infarction: a randomised controlled trial

Background

Exercise-based cardiac rehabilitation (CR) is a non-pharmacological multidisciplinary programme for individuals after myocardial infarction (MI) that offers multiple health benefits. One of the greatest barriers to CR participation is the travel distance to the rehabilitation centre. Remotely monitored CR appears to be at least as effective in improving cardiovascular risk factors and exercise capacity as traditional centre-based CR. Nevertheless, the efficacy of remotely monitored CR in individuals with a recent MI has yet to be examined.

Methods

A total of 30 individuals (8 women, 22 men) after a recent (i.e., <4 weeks) MI were randomly allocated into two groups (online home-based and gym-based groups). Both groups underwent a 26-week CR programme three times per week. All patients performed baseline and 24-week follow-up measurements where peak oxygen uptake (VO2peak), mean daily steps, distance, and calories were assessed.

Results

The online group showed an improvement in mean daily steps (p < 0.05) and mean daily distance (p < 0.05) at 24 weeks compared to the gym-based group. The paired-sample t-test showed that all the assessed variables were statistically (p < 0.001) improved for both groups at 24 weeks. Pearson's r demonstrated positive correlations between VO2peak and mean daily distance (r = 0.375), and negative correlations between VO2peak and muscle (r = -0.523) and fat masses (r = -0.460). There were no exercise-induced adverse events during the study.

Conclusion

Our findings might indicate that a real-time online supervised CR exercise programme using wearable technology to monitor the haemodynamic responses in post-MI patients is equally effective as a gym-based exercise programme.

Risk factors for in-patient myocardial infarction following total hip arthroplasty

Purpose

The aim of this study was to identify potential risk factors for myocardial infarction immediately following total hip arthroplasty.

Methods

The 2016-2019 Nationwide Inpatient Sample database was used to identify patients who underwent primary total hip arthroplasty (THA) and suffered a myocardial infarction (MI). Patient data including demographics, admission, and comorbidities were recorded. Univariate analysis and subsequent multivariate logistic regression were performed to determine which circumstances affected the odds of MI.

Results

A total of 367,890 patients were identified for THA with 142 of those also having a myocardial infarction. Those who experienced an MI had increased length of stay, total charges, and generally negative dispositions compared to their non-MI counterparts (p < 0.001). Through regression analysis, factors that increased the odds of MI included older age [odds ratio (OR) 1.59, 95 % confidence interval (CI) 1.49-1.70], a female sex (OR 1.46, 95 % CI 1.37-1.55), previous coronary artery bypass graft (OR 1.20, 95 % CI 1.01-1.43), obesity (OR 1.12, 95 % CI 1.04-1.21), colostomy (OR 2.07, 95 % CI 1.21-3.56), and Parkinson's disease (OR 1.48, 95 % CI 1.13-1.95). Factors that decreased that risk included elective admission (OR 0.21, 95 % CI 0.19-0.22) and a tobacco related disorder (OR 0.69, 95 % CI 0.63-0.76).

Conclusions

Patient risk for myocardial infarction following total hip arthroplasty varies in part based on their background and comorbidities. These findings can be used to better recognize those who should receive further precautions and tailor proper treatment strategies for THA.

The Masquerade of Myocardial Infarction as Gastroenteritis: A Diagnostic Challenge

Acute coronary syndrome (ACS) can present with varied symptomatology, often deviating from classic presentations, particularly in patients without the characteristic chest pain. This case report describes an ST-elevation myocardial infarction (STEMI) that closely mimicked acute gastroenteritis, illustrating the challenges of differential diagnosis in atypical ACS presentations. We present the case of a 65-year-old Japanese male with a history of hypertension and dyslipidemia who arrived at the emergency department with acute abdominal pain, vomiting, diarrhea, and fever, symptoms suggesting viral gastroenteritis. The absence of chest pain diverted initial clinical suspicion away from cardiac causes. However, cardiovascular risk factors and a gallop rhythm prompted further cardiovascular evaluation. Subsequent blood tests and electrocardiogram findings suggested an acute myocardial infarction, later confirmed by coronary angiography as STEMI due to a 90% stenosis in the right coronary artery, which was successfully treated with percutaneous coronary intervention. The presentation of myocardial infarction can vary, with non-chest pain symptoms such as vomiting and fever occasionally leading the clinical picture, which may result in diagnostic delays and worsened prognosis. This case was particularly challenging due to the presence of all four symptoms typically associated with gastroenteritis, as well as the sequence of symptom onset being atypical for gastrointestinal diseases. This case exemplifies the need for a high degree of clinical suspicion for ACS in patients with atypical presentations, such as those mimicking gastroenteritis, to prevent misdiagnosis and ensure prompt and appropriate management, especially in patients with known cardiovascular risk factors.

Characteristics and clinical outcomes of patients with sarcoidosis admitted for ST-elevation myocardial infarction in the United States: a propensity matched analysis from the National Inpatient Sample

Introduction

Sarcoidosis is a systemic inflammatory disorder characterised by non-caseating granulomas. Cardiac sarcoidosis (CS) normally causes conduction abnormalities, ventricular arrhythmias, and heart failure. Little is known about the characteristics and impact of sarcoidosis in patients admitted with ST-elevation myocardial infarction (STEMI). This study aims to fill this void.

Material and methods

Utilising the National Inpatient Sample (NIS) database (2016-2020), individuals with STEMI were identified and categorised based on sarcoidosis presence whilst adjusting for confounders via logistic regression models.

Results

Among 851,290 STEMI patients, 1215 had sarcoidosis. Before propensity matching, sarcoidosis patients were notably different in demographics and comorbidities compared to non-sarcoidosis patients. After propensity score matching (PSM), sarcoidosis patients were found to have a higher incidence of supraventricular tachycardia (SVT) (2.5% vs. 1.3%, p = 0.024) and acute kidney injury (AKI) (23.3% vs. 20.8%, aOR = 1.269, 95% CI: 1.02-1.58, p = 0.033) but a lower incidence of undergoing coronary artery bypass graft (CABG) (5.5% vs. 8.5%, aOR = 0.663; 95% CI: 0.472-0.931, p = 0.018), while no significant disparities were noted in PCI, cardiogenic shock, mortality, or mean length of stay (LOS).

Conclusions

Using propensity-matched large real-world data of STEMI patients, sarcoidosis was associated with fewer cases of CABG and a greater incidence of AKI and SVT compared to non-sarcoidosis patients.

Sex and ethnic differences in unrecognized myocardial infarctions: Observations on recognition and preventive therapies from the multiethnic population-based HELIUS cohort

Background

Epidemiological studies suggest sex differences in the prevalence and characteristics of unrecognized and recognized myocardial infarction (uMI, rMI). Despite increasingly diverse populations, observations are limited in multiethnic contexts. Gaining better understanding may inform policy makers and healthcare professionals on populations at risk of uMI who could benefit from preventive measures.

Methods

We used baseline data from the multiethnic population-based HELIUS cohort (2011-2015; Amsterdam, the Netherlands). Using logistic regressions, we studied sex differences in the prevalence and proportion of uMIs across ethnic groups. Next, we studied whether symptoms, clinical parameters, and sociocultural factors were associated with uMIs. Finally, we compared secondary preventive therapies in women and men with a uMI or rMI. We relied on pathological Q-waves on a resting electrocardiogram as the electrocardiographic signature for (past) MI.

Results

Overall, and in Turkish and Moroccan subgroups, the prevalence of uMIs was higher in men than women. The proportion of uMIs was similar in women (21.0%) and men (18.4%), yet varied by ethnicity. In women and men, symptoms (chest pain, dyspnea) and clinical parameters (hypertension, hypercholesterolemia), and in women also lower educational level and diabetes were associated with lower odds of uMIs. Women (0.0%) and men (3.6%) with uMI were unlikely to receive secondary preventive therapies compared to those with rMI (28.1-40.9%).

Conclusions

The prevalence of uMIs was higher in men than women, and sex differences in the proportion of uMIs varied somewhat across ethnic groups. People with uMIs did not receive adequate preventative medications, posing a risk for recurrent events.

Sex differences in cardiometabolic risk factors and in response to lifestyle intervention in prepubertal and pubertal subjects with obesity

Objectives

Childhood obesity is a growing health problem and requires a tailored treatment. This study explored the sex differences in cardiovascular risk factors in children/adolescents with obesity and in response to a weight loss intervention.

Methods

Five hundred and thirty-three children/adolescents with obesity and their parents underwent to a 3-months lifestyle intervention program. Tanner criteria were used to assess the pubertal stage. Before and after 3 months, anthropometric measurements, blood pressure (BP), and biochemical measurements were assessed.

Results

Four hundred and forty five participants completed the treatment (age 12.4 ± 2.7 years, males 45.8%, prepubertal 29.2%, BMI z score 2.3 ± 0.2). In comparison to boys, prepubertal girls had higher values of BMI z score (2.4 ± 02 vs. 2.3 ± 0.2, p < 0.05), waist circumference z score (2.2 ± 0.3 vs. 2.0 ± 0.3, p < 0.05), HOMA-IR [2.9 (2.1-4.9) vs. 2.3(1.5-3.6), p < 0.01], prevalence of hypertransaminasemia (41.3% vs. 17.7%, p < 0.05) and lower levels of HDL cholesterol (46.2 ± 9.8 vs. 51.2 ± 10.5 mg/dl, p < 0.05). In the pubertal stage, boys had worse cardiometabolic risk profile than girls, including unfavourable measure of systolic BP (z score: 0.6 ± 1.0 vs. 0.3 ± 1.0, p < 0.01), fasting glucose (87.2 ± 6.1 vs. 84.8 ± 7.7 mg/dl, p < 0.01), ALT (26.9 ± 21.5 vs. 20.2 ± 10.6 U/L, p < 0.001) and uric acid (6.1 ± 1.9 vs. 5.0 ± 1.0 mg/dl, p < 0.001). After the lifestyle intervention, changes in BMI z score (p < 0.05) were higher in pubertal boys than pubertal girls. The systolic blood pressure decrease was greater in pubertal boys than in their female counterpart (Δ systolic BP: -7.2 mmHg in boys vs. -3.6 mmHg in girls, p < 0.05; Δ systolic BP z score: -0.6 in boys vs. -0.3 in girls, p < 0.05). LDL cholesterol showed an improvement only in boys, and ALT in the whole group.

Conclusion

Our study showed that a short-term lifestyle intervention is more effective in reducing BMI z score and cardiovascular risk factors in pubertal boys than in their female counterparts. Further investigation is needed to deepen this gender difference, especially to develop a tailor-made intervention.

Silent Myocardial Infarction: A Case Report

Silent myocardial infarction (SMI) is a type of myocardial infarction (MI) that is asymptomatic or demonstrates mild symptoms; therefore, patients often do not seek medical treatment. SMI cases are often incidentally detected later by electrocardiogram (ECG). We present a case of a 59-year-old overweight woman with prediabetes, primary hypertension, and hypercholesterolemia who presented for herpes zoster (HZ) follow-up; she reported having skipped heartbeats and heart rate fluctuations during the review of systems. On further workup, ECG revealed low voltage QRS complexes, flat QRS complexes, flat T waves, and pathological Q waves, suggesting the diagnosis of SMI. Based on the identified risk factors, including high BMI, prediabetes, primary hypertension, hypercholesterolemia, HZ, and newly diagnosed SMI, the patient was advised to continue with lisinopril 20 mg daily, prescribed atorvastatin 80 mg daily, and was educated about maintaining a healthy diet, exercise, and receiving the shingles vaccination. To prevent the possible risks of poor outcomes such as those following MI, stroke, heart failure, arrhythmias, angina, and shortness of breath (SOB), the patient was referred to the cardiologist for a stress test and further treatment plan.