Yamaguchi Syndrome: An Important Consideration in the Differential Diagnosis of Chest Pain in the Emergency Department.

Non-obstructive hypertrophic cardiomyopathy, or apical hypertrophic cardiomyopathy (ApHCM), also referred to as Yamaguchi syndrome, is a type of hypertrophic cardiomyopathy (HCM) characterized by significant thickening of the left ventricular apex without blockage in the left ventricular outflow tract. It is a very rare variant of HCM. Patients with non-obstructive HCM often experience symptoms such as chest pain, palpitations, shortness of breath, and syncope, which may resemble those seen in various cardiovascular and non-cardiac conditions. Yamaguchi syndrome presents as a challenging yet manageable condition in the ED. Early recognition, accurate diagnosis, and appropriate management are crucial for better outcomes. We report a case of a young female who presented to the ED with breathlessness and chest pain. The ECG findings suggested acute coronary syndrome (ACS), but echocardiography and cardiac biomarkers indicated otherwise, leading to the diagnosis of Yamaguchi Syndrome.

Age-Related Patterns of Symptoms and Risk Factors in Acute Coronary Syndrome (ACS): A Study Based on Cardiology Patients' Records at Rehman Medical Institute, Peshawar.

Introduction Acute Coronary Syndrome (ACS) is a critical condition characterized by reduced blood flow to the heart and includes various conditions such as ST-elevation myocardial infarction, non-ST elevation myocardial infarction, and unstable angina. Objectives The aim of this study was to investigate age-related patterns of symptoms and risk factors in ACS patients and to evaluate how diagnostic test results differ among various age groups of ACS patients. Methodology This retrospective study was conducted from May to November of 2023 on patients with acute coronary syndrome admitted to the cardiology ward of Rehman Medical Institute (RMI), Peshawar. The sample size was 137 ACS-diagnosed patients based on the inclusion and exclusion criteria. After getting ethical approval from the institutional ethical approval board, data were collected for the entire year of 2022 based on proforma with the variables demographic data, troponin I level, presented symptoms, and associated co-morbidities of the patients. The inclusion criteria were patients of all genders, patients diagnosed with Acute Coronary Syndrome (ACS), and patients whose records were available in the cardiology department of Rehman Medical Institute.  Results The results show that ACS is more prevalent in the age group of 50-69 years (p=0.037) and is significantly more common in males (p=0.019). Chest pain emerged as the predominant symptom, with a significant association of p=0.029 between chest pain and patients of ACS in the age group 30-49 years. While raised troponin I levels were prevalent across all age groups. Moreover, specific risk factors such as diabetes mellitus, hypertension, and family history of CAD showed the significance of p= 0.04, p=0.006, and p=0.021, respectively, with the age group 50-69 years old. Conclusion This study highlights the importance of considering age and gender in ACS management and provides insights into age-related patterns of symptoms and risk factors, which can contribute to optimizing preventive strategies and improving patient care. Further research is needed to explore the underlying mechanisms and assess long-term outcomes in different age groups.

Novel Intracoronary Infusion of Supersaturated Oxygen Therapy in Patients Presenting With Acute ST Elevation Myocardial Infarction: Does It Help?

Supersaturated oxygen (SSO2) is one of the emerging therapies that has shown benefit for patients suffering from acute ST elevation myocardial infarction (STEMI) in terms of reducing infarct size, which has been used as a prognostic indicator for future heart failure and hospitalizations. Trials investigating SSO2 therapy have shown improvement in infarct size when used as an adjunct therapy to percutaneous trans-luminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI) in patients presenting with acute myocardial infarction (aMI).  Here we present a patient with a mid left anterior descending artery (mLAD) STEMI who underwent SSO2 therapy. The patient presented with new onset angina and ST elevations on EKG. He underwent emergent coronary angiography, which confirmed an mLAD complete vessel occlusion. Successful PCI was done with a drug-eluting stent followed by supersaturated oxygen therapy. On follow-up evaluation, the patient had improved left ventricular (LV) ejection fraction from 35% to 60%. This case highlights the safety and efficacy of SSO2 therapy for patients suffering from acute anterior wall myocardial infarction. We recommend further investigation of this therapy for its routine use, safety, and prognostic utility. We also recommend routine use of adjunctive SSO2 therapy for patients suffering acute anterior STEMI.

Increased Neck Circumference and Increased Waist-Hip Ratio: Predictive Factors of Acute Myocardial Infarction.

Background We hypothesize that neck circumference (NC) is a better predictor of acute myocardial infarction (AMI) compared to the waist-hip ratio (WHR) in patients presenting with acute coronary syndrome (ACS). The objective of this study is to investigate the association between NC and WHR with AMI and determine whether NC is a superior predictor of AMI in ACS patients compared to WHR. Methods This cross-sectional observational study was conducted in the Department of Cardiology at the Medical Teaching Institute, Lady Reading Hospital, Peshawar. The study lasted from February 20, 2018, to September 12, 2018. Patients having ACS who presented to the emergency department were enrolled via non-probability convenient sampling. Demographic data and baseline variables, including NC and WHR, were documented using a pre-designed pro forma. SPSS V.20 (IBM Corp, Armonk, NY) was used for data analysis. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Chi-square tests were performed to determine the association between variables, and logistic regression models were used to measure odds ratios (ORs). Results In this study, 180 patients were included, with a mean age of 54.48±8.48 years and a male predominance of 51.5%. The results indicated a significant association between increased NC and WHR with AMI. The chi-square values for NC and WHR were 78.26 (p≤0.001) and 43.38 (p≤0.001), respectively. As NC increased from <37 cm to >38.5 cm, the OR for AMI increased from 0.46 to 4.51. Furthermore, the prevalence odds ratio (POR) of AMI increased by 2.185 times with an increase in WHR from 0.90. Conclusion Increased NC and increased WHR are statistically significantly associated and strong predictors of AMI in ACS patients. However, NC being more reliable, effective, and user-friendly should be the preferred measure.

Clinical Features of the Aslanger Pattern to Compensate for the Limitation of ST-Elevation Myocardial Infarction (STEMI) Criteria.

BACKGROUND: ST-elevation is one of the most valuable electrocardiogram findings to diagnose acute myocardial infarction. However, more than a quarter of acute coronary occlusions are missed by this criterion, causing a delay in revascularization. Therefore, there should be awareness of the limitations of the current criteria and new electrocardiographic findings are required as a diagnostic tool to compensate for them. The Aslanger pattern is a specific electrocardiographic finding in acute inferior myocardial infarction with multivessel disease and allows the detection of inferior myocardial infarction that does not show ST-elevation, leading to rapid revascularization. However, in patients with the Aslanger pattern, the hemodynamic characteristics, such as the rate of shock and the use of mechanical circulatory support, as well as prognostic characteristics such as the in-hospital mortality rate, have not yet been clarified. METHODS: In this study, we retrospectively surveyed the current practice on the basis of ST-elevation myocardial infarction (STEMI) criteria in patients with acute coronary artery occlusion presenting with inferior myocardial infarction. We examined the clinical characteristics of the Aslanger pattern. RESULTS: Based on the STEMI criteria, 71.8% (51/72) of patients were diagnosed with STEMI from an acute electrocardiogram, and 28.2% (21/78) were diagnosed with non-STEMI. As expected, ruling out in all acute coronary artery occlusions using STEMI criteria alone was difficult. A total of 48% of patients with non-STEMI had the Aslanger pattern. In addition, 80% of patients with the Aslanger pattern had multivessel disease, 30% had the use of the mechanical circulatory support, and 20% had in-hospital mortality. CONCLUSION: This study suggests that the Aslanger pattern is useful not only for diagnosis, but also for predicting hemodynamic collapse and a poor prognosis. Therefore, we should share information on Aslanger pattern with other physicians and use this pattern in daily practice.

The Efficacy and Safety of Antiplatelet Therapy in Patients With Acute Coronary Syndrome: A Scoping Review.

Cardiovascular disease, predominantly acute coronary syndrome (ACS), is the leading cause of death for both men and women. For decades, this has been a global healthcare challenge. The main reason for thrombus formation in the coronary arteries is platelet accumulation as part of an inflammatory reaction. The efforts to combat this process of platelet aggregation have led researchers to discover antiplatelet drugs, which have been a keystone in treating cardiovascular diseases related to arterial thrombus formation. Antiplatelet drugs inhibit various platelet responses and help mitigate atherothrombosis, thereby playing a major role in both primary and secondary prevention of ACS. This study employs a scoping review approach to recapitulate the data in the existing literature regarding the efficacy and safety of antiplatelet therapy in patients with ACS. By searching a total of 14,882 journals that were published between 2013 and July 26, 2023, 10 papers were selected for in-depth analysis. We conducted this literature search by using PubMed and Google Scholar databases and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the corresponding PRISMA Extension for Scoping Reviews in performing this review.  The review findings revealed that the current approach of using antiplatelet agents in ACS is safe and efficient, provided that bleeding risk assessment is conducted and any prior contraindications are recognized before administering the drugs. Ethical approval was not required for this review as it involved secondary data collection from published journals. The findings of this scoping review will be published in peer-reviewed journals and presented at conferences.