Larisa Anghel, Cristina Prisacariu and Cătălina Arsenescu Georgescu
Introduction: Cardiovascular disease is the leading cause of death among women irrespective of race or ethnicity, and about half of these deaths are caused by coronary artery disease. Several studies have reported that cardiovascular diseases manifest themself with a delay of about 7–10 years in women and that they have higher in-hospital mortality. It has not yet been established whether female gender itself, through biological and sociocultural differences, represents a risk factor for early in-hospital mortality in ST-segment elevation acute myocardial infarction (STEMI). The aim of our study was to identify the angiographic particularities in women with STEMI from North East Romania.
Material and Methods: For one year, 207 (31.7%) women and 445 (68.3%) men diagnosed with acute myocardial infarction were hospitalized in the Cardiology Clinic of the “Prof. Dr. George I. M. Georgescu” Institute of Cardiovascular Diseases in Iași, Romania.
Results: The highest incidence of symptom onset was between 6:00 a.m. and 12:00 a.m., this morning polarization being more obvious in women. Within the first two hours of admission to the hospital, coronary angiography was performed in 78.1% of men and only 67.3% of women, the difference being statistically significant (p <0.05). We found that a large number of women had multivascular coronary disease (47.9% vs. 42.3%). At the same time, we found that left main disease and multivascular disease were more frequent in women than in men (3.8% vs. 0.7%, p = 0.001 for left main plus two-vessel disease, and 19.4% vs. 14.8%, p = 0.0005 for three-vessel disease).
Conclusions: In women, coronary events began more frequently in the morning, with atypical symptoms; also, fewer women presented to the hospital within the first 12 hours after the onset of the acute event. Compared to men, women from North East Romania present a higher incidence of multivascular atherosclerotic coronary lessions, indicating a higher severity of STEMI in the female population from this geographical area.
Larisa Anghel, Eduard Dabija, Liviu Macovei, Cristina Prisacariu, Mihaela Viviana Ivan and Cătălina Arsenescu Georgescu
Introduction: Cardiac arrhythmias caused by electrical injuries are rare among emergency service admittances. We present a case of ventricular fibrillation (VF) with a rare etiology, confirmed by speckle-tracking imaging.
Case presentation: A 38-year-old man was addressed to our hospital to evaluate the etiology of an episode of VF, promptly resuscitated in a territorial hospital. On admission, his 12-lead electrocardiogram revealed a sinus rhythm, without any ST-T changes or atrioventricular conduction disorders. Transthoracic echocardiography and coronary angiography were normal, and the electrophysiological study did not induce VF. Anamnesis showed that the arrhythmia occurred after an electrical injury, resulting from the contact with a domestic low-voltage source. Speckle-tracking imaging revealed closure of the electric arc within the heart, which could explain the absence of skin-burn injuries in this case. The patient was discharged after seven days of hospitalization, without any complication.
Conclusions: VF can occur after an unexpected electrical shock during a household accident. This case report underlines the need for a complex interdisciplinary approach in such difficult cases, when the absence of any electrical injuries on the skin makes it difficult to recognize the electrical shock that triggered the ventricular fibrillation.
Larisa Anghel, Cristina Prisacariu, Radu Sascău, Liviu Macovei, Elena-Cătălina Cristea, Georgiana Prisacariu and Cristian Stătescu
Coronary heart disease occurs more often in patients over the age of 45. However, recent data shows a growing incidence of coronary events in younger patients also. Young patients with acute myocardial infarction (AMI) represent a relatively small proportion of subjects suffering from an acute ischemic event. However, they represent a subset that is distinguished from elderly patients by a different profile of risk factors, often atypical clinical presentation, and different prognosis. The prevalence of risk factors such as smoking, dyslipidemia, and a family history of coronary events is higher in this group of patients compared to the general population with AMI. Because of an important negative impact on the patients’ psychology, impaired working abilities, and a high socioeconomical burden, myocardial infarction in young patients represents an important cardiovascular pathology. This manuscript aims to present the particularities of AMI occuring at a young age, in comparison with the rest of the population with AMI.