European Journal of Cardiovascular Medicine

Introduction: Cardiac hemangiomas are rare benign vascular tumors accounting for nearly 2% of all benign cardiac neoplasms. They may remain asymptomatic or present with varied clinical manifestations depending on their size and anatomical location. Presentation as acute coronary syndrome (ACS) is extremely uncommon and poses significant diagnostic challenges. Case Presentation: A 58-year-old chronic smoker presented with sudden onset typical anginal chest pain associated with retrosternal heaviness and diaphoresis. Electrocardiography showed pathological Q waves in the inferior leads, and high-sensitivity troponin-I levels were elevated more than three times the upper limit of normal. Transthoracic echocardiography revealed a 3.5 × 3.2 cm heterogeneous echogenic mass within the mid-apical interventricular septum protruding into the right ventricular cavity with both arterial and venous flow on color Doppler imaging. Coronary angiography demonstrated non-critical left circumflex artery disease and a highly vascular lesion supplied by feeder vessels arising from the right coronary artery and septal branches of the left anterior descending artery, suggestive of cardiac hemangioma. Cardiac magnetic resonance imaging confirmed a vascular mass in the interventricular septum with characteristic progressive post-contrast enhancement along with ischemic changes in the inferior and inferolateral left ventricular walls. The patient was managed conservatively with beta-blockers, antiplatelet agents, and antianginal therapy, with surgical excision planned if symptoms persisted during follow-up. Conclusion: Cardiac hemangioma presenting as acute coronary syndrome is exceedingly rare. Multimodality imaging including echocardiography, coronary angiography, and cardiac magnetic resonance imaging plays a pivotal role in diagnosis and treatment planning. Early recognition of this rare entity is important to differentiate it from other cardiac tumors and to guide appropriate management.

Introduction: Peripheral nerve blocks are effective for postoperative pain management in lower limb surgeries. The addition of adjuvants to local anesthetics can enhance the quality and duration of analgesia. Aim: This study aimed to compare the efficacy and safety of clonidine versus dexmedetomidine as adjuvants to levobupivacaine in ultrasound-guided femoro-sciatic nerve blocks for lower limb surgeries. Materials and Methods: In this prospective, randomized, double-blind study, 90 ASA I-II patients scheduled for lower limb surgeries were randomly allocated into two groups. Group A (n=45) received levobupivacaine with clonidine (1 μg/kg), and Group B (n=45) received levobupivacaine with dexmedetomidine (1 μg/kg) for ultrasound-guided femoro-sciatic nerve blocks. Postoperative pain was assessed using Visual Analog Scale (VAS) scores at 0, 2, 4, 8, 12, and 24 hours. Secondary outcomes included hemodynamic parameters (heart rate, blood pressure), motor blockade (Bromage score), and side effects (bradycardia, hypotension, nausea/vomiting). Results: Demographic parameters were comparable between the groups. VAS scores were significantly lower in the dexmedetomidine group compared to the clonidine group at all time points (p<0.001). Bromage scores, indicating motor blockade, were significantly higher in the clonidine group at 2, 4, and 8 hours (p<0.001). The dexmedetomidine group had a significantly higher incidence of bradycardia (33.3% vs. 15.6%, p=0.050) and hypotension (26.7% vs. 4.4%, p=0.004). Systolic blood pressure was significantly lower in the dexmedetomidine group at 4 and 8 hours (p=0.009 and p=0.026, respectively). Mean arterial pressure showed significant differences at multiple time points with variable patterns. Conclusion: Dexmedetomidine provides superior analgesia compared to clonidine when used as an adjuvant to levobupivacaine in femoro-sciatic nerve blocks but is associated with a higher incidence of cardiovascular side effects. Clonidine results in more intense motor blockade with a more favorable cardiovascular profile. The choice between these adjuvants should be individualized based on patient characteristics and surgical requirements.

Background: Brachial plexus blocks are widely used for upper limb surgeries, with various adjuvants being employed to enhance block quality and prolong postoperative analgesia. This study compared the efficacy of clonidine versus dexmedetomidine as adjuvants to ropivacaine in ultrasound-guided supraclavicular brachial plexus block for patients undergoing upper limb surgeries.  Methods: This prospective, randomized, double-blind study included 106 ASA I-II patients aged 18-60 years undergoing upper limb surgeries. Patients were randomly allocated into two groups (n=53 each): Group A received 30 ml of 0.5% ropivacaine with clonidine 2 μg/kg, and Group B received 30 ml of 0.5% ropivacaine with dexmedetomidine 1 μg/kg. Primary outcomes measured included onset and duration of sensory and motor blockade, time to first rescue analgesia, pain scores, and adverse effects. Results: Demographic profiles were comparable between groups. The dexmedetomidine group demonstrated significantly faster onset of sensory block (6.95±1.47 vs 9.28±1.80 min, p<0.001) and motor block (8.70±2.00 vs 12.08±2.40 min, p<0.001). Block duration was also superior with dexmedetomidine for both sensory (668.26±41.65 vs 551.81±43.93 min, p<0.001) and motor components (595.06±42.37 vs 497.94±46.61 min, p<0.001). The dexmedetomidine group exhibited prolonged time to first rescue analgesia (716.45±76.88 vs 579.15±57.30 min, p<0.001), lower pain scores at rescue (3.28±1.10 vs 4.51±1.09, p<0.001), and reduced analgesic requirements (1.92±0.85 vs 3.51±1.15 doses, p<0.001). Hemodynamic parameters remained stable in both groups, with no significant differences in the incidence of adverse effects. Conclusion: Dexmedetomidine is superior to clonidine as an adjuvant to ropivacaine in ultrasound-guided supraclavicular brachial plexus block, providing faster onset, prolonged duration of blockade, extended postoperative analgesia, and a favourable safety profile for patients undergoing upper limb surgeries.

Background and Aims: Accurate assessment of fluid responsiveness remains challenging in surgical patients, with approximately 50% of haemodynamically unstable patients not responding adequately to fluid therapy. The internal jugular vein distensibility index (IJV-DI) has emerged as a potential non-invasive alternative for predicting fluid responsiveness. This study aims to evaluate the accuracy of IJV-DI measurement compared with transthoracic echocardiography in predicting fluid responsiveness in patients undergoing elective surgery. Methods: This prospective cross-sectional study enrolled 33 adult patients (aged 18-65 years) with ASA physical status I-III undergoing elective surgery under general anaesthesia. Following anaesthesia induction and mechanical ventilation, baseline IJV-DI and stroke volume (SV) measurements were performed using ultrasonography and transthoracic echocardiography respectively. After administering 250 mL crystalloid fluid challenge, measurements were repeated. Patients with >10% increase in stroke volume were classified as fluid responders. The primary outcome was diagnostic accuracy of IJV-DI in predicting fluid responsiveness. Data were analyzed using receiver operating characteristic (ROC) curve analysis, Youden index for optimal cut-off determination, and Spearman's correlation test. Results: Of 33 patients, 19 (57.6%) were fluid responders. The ROC analysis revealed an area under the curve (AUC) of 0.863 (95% CI: 0.731, 0.995). The optimal cut-off value was IJV-DI >13.45% with sensitivity of 84.2% and specificity of 78.6%. Positive predictive value was 0.84 (95% CI: 0.64, 0.95) and negative predictive value was 0.79 (95% CI: 0.54, 0.94). A moderate positive correlation existed between IJV-DI and stroke volume increase (r = 0.542, P < 0.001). Conclusion: IJV-DI assessment demonstrates good diagnostic accuracy in predicting fluid responsiveness in elective surgery patients and is comparable with transthoracic echocardiography stroke volume measurement. This simple, non-invasive bedside tool may help optimize intraoperative fluid management.

Background: Shock index (SI) is calculated as heart rate divided by systolic blood pressure. In the obstetric population, SI of ≥0.9 is associated with maternal adverse outcomes. Our primary aim was to investigate the association between preoperative SI and post-spinal hypotension in non-elective cesarean section. Methods: In this prospective, cross-sectional study, term parturient of ASA physical status I and II, undergoing non-elective cesarean section with spinal anesthesia were enrolled. We performed univariable and multivariable logistic regression to explore the association between baseline SI (categorized as <0.9 and ≥0.9) and hypotension after spinal anesthesia. The diagnostic ability of the baseline SI to predict post-spinal hypotension was assessed using ROC (receiver operating characteristics) curves. Results: Ninety-six parturients were enrolled and analyzed. Forty-five (46.88%) parturients developed post-spinal hypotension, and thirty-three (34.38%) reported post-delivery hypotension. Preoperative SI (adjusted odds ratio [AOR], 2.84; 95% CI, 1.08–7.46; p=0.034) and thoracic sensory block height >T4 (AOR, 2.41; 95% CI, 1.02–5.68; p=0.045) were associated with post-spinal hypotension. Preoperative SI (AOR, 4.52; 95% CI, 1.58–12.91; p=0.005) was significantly associated with post-delivery hypotension. Area under the ROC curve for SI alone in predicting hypotension before and after delivery was 0.54 (95% CI 0.43–0.65) and 0.57 (95% CI 0.46–0.68) respectively. However, the model performance as reflected by ROC curve for the multivariable logistic regression analysis was 0.638 for post-spinal hypotension and 0.692 for post-delivery hypotension, respectively. Conclusion: In parturients undergoing non-elective cesarean section, baseline SI ≥0.9 was associated with post-spinal and post-delivery hypotension. While the SI alone showed limited predictive power for post-spinal and post-delivery hypotension, integrating it with other risk factors improved the model's predictive ability.

Background: Medication administration errors continue to pose a significant perioperative safety problem in that anaesthesia is a risky environment that requires high-pressure, rapid drug preparation and delivery. Self-reported errors in administering drugs are a known problem of anaesthesia providers, but there are no resident-based findings on knowledge attitude and practice across training years. Methods: A cross-sectional questionnaire study in anaesthesia residents of tertiary care teaching hospitals was carried out within 1 month. Knowledge, attitude, and practice were assessed medication administration errors for with Likert-scale items and close-ended items using a 20-item online instrument with convenience sampling (validated by two senior faculty). The domain scores were assigned to poor (<50%), moderate (50–74%), and good (≥75%). The categorical correlations were computed with chi-square/Fisher’s exact tests, and ordinal was subjected to nonparametric tests for comparison across training years; p<0.05 was considered statistically significant. Results: There were 236 residents who participated in the study (mean age 27.4±2.1 years; 52.1% female). Knowledge about medication administration errors was good in 41.1%, moderate in 45.8%, and poor in 13.1%. The positive attitude towards safe medication behaviours was higher (good: 52.5%) and safe practices were lower (good: 34.3%). Knowledge and practice scores increased with seniority: senior residents showed a median practice score that was larger than those of the first year (p<0.001). Look-alike/sound-alike drugs, syringe swaps, fatigue, and interruptions were frequent (self-reported) causes of medication administration errors factors aligned with perioperative human-factors literature. Conclusion: Anaesthesia residents showed moderate overall knowledge and generally favorable attitudes, but practice gaps were evident–especially amongst junior trainees. Structured resident-focused medication safety training, standardized labeling/workflow, and low-barrier incident reporting systems may improve safe practices as well as reduce preventable harm.

Background: Unexpected difficult airway is still one of the most challenging problems in anaesthetic practice and has a major contribution to perioperative morbidity and mortality. Typical bedside airway assessment tests, including the Modified Mallampati classification, thyromental distance, and inter-incisor gap, have limited sensitivity and specificity in predicting difficult intubation. Ultrasonography (USG) has recently become a non-invasive tool with the ability to assess airway anatomy in real time. We aimed to assess the role of preoperative airway ultrasonographic parameters in predicting difficult intubation and to compare their diagnostic accuracy with Cormack–Lehane (CL) grading obtained using direct laryngoscopy. Methods: A prospective cross-sectional study of 185 adults 18–60 years old with ASA physical status I–II undergoing elective surgery under general anaesthesia with endotracheal intubation in a tertiary care teaching hospital. Traditional airway assessment and ultrasonographic measurements of hyomental distance in neutral and extended positions (HMDn, HMDe), hyomental distance ratio (HMDR), pre-epiglottic space (PreE), epiglottis-to-vocal cord distance (E-VC), and the PreE/E-VC ratio were performed for preoperative assessment. Following induction of anaesthesia, direct laryngoscopy was performed and CL grading recorded. Difficult intubation was defined as CL grade III or IV or requirement of three or more intubation attempts. Statistical analysis utilized t-test, chi-square test, correlation analysis, and receiver operating characteristic (ROC) curves. Results: Out of 185 patients, 25 (13.5%) underwent a difficult intubation. Difficult intubation was associated with significantly lower HMDR and greater anterior neck soft tissue thickness at the level of the epiglottis and vocal cords (p<0.05). The best predictive accuracy for difficult airway was found with the PreE/E-VC ratio at AUC 0.86, followed by HMDR (AUC 0.82). Ultrasonographic parameters revealed higher sensitivity than conventional bedside airway tests. Conclusion: Airway ultrasonography provides reliable, objective parameters for predicting difficult intubation. Measurements such as HMDR and PreE/E-VC ratio show promising diagnostic accuracy and may complement conventional airway assessment methods. Integration of airway ultrasonography into routine preoperative evaluation may improve anticipation and management of difficult airways.

Background: Unanticipated difficult laryngoscopy and endotracheal intubation remain important contributors to perioperative airway morbidity. The modified Mallampati test (MMT) is routinely used to screen for difficult airways, but its predictive performance varies across studies, partly due to inconsistent test technique—particularly whether phonation is permitted during assessment. Methods: A hospital-based cross-sectional study was conducted over 3 months among 95 adults (18–65 years) scheduled for elective surgery under general anaesthesia requiring tracheal intubation. Each participant underwent preoperative MMT assessment in the sitting position both without phonation and with phonation (“ah”). Direct laryngoscopy was performed using a Macintosh blade (size 3 or 4). Laryngeal view was graded by the Cormack–Lehane (CL) classification. Difficult laryngoscopy was defined as CL grade III–IV. Difficult intubation was additionally evaluated using the Intubation Difficulty Scale (IDS), with IDS >5 defining difficult intubation. Diagnostic indices (sensitivity, specificity, PPV, NPV, accuracy) were calculated for each MMT approach. Results: There was difficulty in intubation in 11/95 (11.6%) patients. For test positive MMT Class III/IV, MMT without phonation had an increase in sensitivity: 81.8% sensitivity; specificity: 71.4%; PPV: 27.3%; NPV: 96.8%; and accuracy: 72.6%. MMT with phonation displayed sensitivity 63.6%, specificity 86.9%, PPV 38.9%, NPV 94.8%, and accuracy 84.2%. There was a moderate agreement between the two methods (κ ≈ 0.60). Phonation shifted a significant amount of patients toward lower Mallampati classes, reducing false positives but missing some harder cases. Conclusion: In this group, using phonation as an additional step to MMT increased specificity and accuracy, but decreased sensitivity for difficult intubation. Phonated MMT may be helpful to “ruling in” risk when positive, however non-phonated MMT does a better job of “screening” to minimize missed difficult airways. The multivariable assessment is still necessary for further investigation.

Background: Transgender individuals experience significant health disparities and barriers to accessing equitable healthcare, which may indirectly contribute to adverse cardiovascular and overall health outcomes through delayed care, stress, and inadequate preventive services. Aim: To assess challenges in healthcare access, informed consent, discrimination, and confidentiality among transgender individuals in Ernakulam District, Kerala. Methods: A cross-sectional study was conducted among 106 self-identified transgender adults using a structured, pre-validated questionnaire. Data were analyzed using descriptive statistics to evaluate domains including access to healthcare, provider competence, informed consent practices, stigma, and privacy. Results: Only 36.8% of participants reported access to healthcare providers knowledgeable in transgender health. Fear of discrimination led 38.7% to avoid seeking care, while 33% reported denial of treatment based on gender identity. Communication gaps were evident, with only 34% discussing reproductive or sexual health concerns with providers. Informed consent practices were suboptimal, with only 50% receiving adequate information prior to hormone therapy, and 57.5% reporting that their treatment decisions were not fully respected. Breaches of confidentiality were reported by 45.3% of participants. Despite these barriers, over 70% of individuals accessing care expressed satisfaction with provider interactions. Conclusion: Significant systemic, ethical, and provider-level barriers persist in transgender healthcare. Strengthening provider training, enforcing non-discrimination policies, and improving informed consent and confidentiality practices are essential to ensure equitable, ethical, and patient-centered care.

Background and Introduction: Balanced general anaesthesia employing adjuvant drugs allows reduction in primary anaesthetic doses while achieving haemodynamic stability, analgesia, and smooth recovery. Dexmedetomidine, a selective α₂-adrenoceptor agonist, is widely used as an intraoperative adjuvant for its sympatholytic, sedative, and analgesic properties. When combined with ketamine—an NMDA receptor antagonist with sympathomimetic properties—or fentanyl—a potent µ-opioid agonist—distinct haemodynamic and recovery profiles may result. Comparative evidence directly evaluating these two combinations in the intraoperative general anaesthesia setting remains limited, necessitating the present study. Aim: To compare the clinical effects of dexmedetomidine with ketamine versus dexmedetomidine with fentanyl as intraoperative adjuvants during general anaesthesia in terms of haemodynamic parameters, recovery characteristics, anaesthetic requirements, postoperative analgesia, and adverse events. Methods: A prospective randomised controlled study was conducted in 54 ASA I–II adult patients undergoing elective surgery under general anaesthesia. Patients were randomised equally into Group DK (dexmedetomidine + ketamine, n = 27) and Group DF (dexmedetomidine + fentanyl, n = 27). Heart rate, mean arterial pressure, SpO₂, and EtCO₂ were monitored at multiple intraoperative and postoperative time points. VAS pain scores were assessed at the end of surgery and at 2, 4, and 6 hours postoperatively. Muscle relaxant dose, extubation time, Ramsay Sedation Score, PACU stay duration, and adverse events were recorded. Data were analysed using independent samples t-test and chi-square/Fisher's exact test. p < 0.05 was considered statistically significant. Results: Both groups were comparable at baseline for all demographic variables (p > 0.05). Heart rate was comparable up to 40 minutes but was significantly higher in Group DK from 65 minutes onward, at extubation (69.30 ± 6.80 vs 62.11 ± 4.56 bpm; p < 0.001), and at 2 hours postoperatively (70.89 ± 6.38 vs 61.93 ± 4.95 bpm; p < 0.001). MAP was comparable through 125 minutes but significantly higher in Group DK from 140 minutes onward, at extubation (79.56 ± 5.42 vs 74.59 ± 6.70 mmHg; p = 0.004), and at 2 hours postoperatively (82.93 ± 7.99 vs 77.19 ± 9.26 mmHg; p = 0.018). SpO₂ and EtCO₂ were comparable throughout. VAS scores were similar at end of surgery and 2 hours, but significantly lower in Group DK at 4 hours (1.67 ± 0.78 vs 3.89 ± 0.85; p < 0.001) and 6 hours (1.78 ± 0.80 vs 4.44 ± 1.09; p < 0.001). Group DF required a significantly higher muscle relaxant dose (4.07 ± 0.87 vs 3.63 ± 0.69 mg; p = 0.043). Extubation time and Ramsay Sedation Scores were comparable. PACU stay was significantly prolonged in Group DF (p = 0.001). All adverse events were infrequent with no statistically significant intergroup differences. Conclusion: Dexmedetomidine with ketamine provides superior intraoperative haemodynamic stability, reduced muscle relaxant requirement, and significantly better postoperative analgesia at 4 and 6 hours compared to dexmedetomidine with fentanyl, along with a shorter PACU stay. Both combinations demonstrated comparable and acceptable safety profiles. The choice of adjuvant combination should be individualised based on surgical requirements, expected postoperative pain, and recovery logistics.

Background: Radical nephrectomy with inferior vena cava (IVC) thrombectomy is a complex surgical procedure associated with significant hemodynamic instability due to major vascular manipulation. Limited data are available on intraoperative hemodynamic trends and anesthetic implications, particularly in the Indian population. Methods: This retrospective observational study included 23 patients who underwent radical nephrectomy with IVC thrombectomy between January 2015 and December 2025 at a tertiary care center. Hemodynamic parameters including heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), systemic vascular resistance (SVR), and stroke volume variation (SVV) were recorded at six predefined surgical phases. Statistical analysis was performed using repeated measures ANOVA or Friedman test, with p < 0.05 considered significant. Results: Significant hemodynamic variations were observed across surgical phases (p < 0.001). During IVC clamping, MAP decreased (58.9 ± 9.5 mmHg) and CO reduced (4.01 ± 0.85 L/min), while SVR increased (1829 ± 165 dynes·sec/cm⁵) and SVV rose (21.3 ± 5.4%). Following clamp release, MAP (101.9 ± 9.8 mmHg) and CO (6.06 ± 0.75 L/min) increased significantly, while SVR and SVV decreased. Mean blood loss was 1450 ± 520 mL, and 82% patients required transfusion. Two patients developed acute kidney injury, and two deaths occurred due to postoperative pulmonary embolism. Conclusion: IVC thrombectomy is associated with marked hemodynamic fluctuations, particularly during clamping and declamping. Advanced hemodynamic monitoring and vigilant anesthetic management with timely vasopressor support are essential to maintain cardiovascular stability and improve perioperative outcomes.

Background: Perioperative cardiac events remain a major cause of morbidity and mortality in patients undergoing non-cardiac surgery. Dobutamine Stress Echocardiography (DSE) is a well-established non-invasive modality for detecting inducible myocardial ischemia and assessing perioperative cardiac risk.  Objective: To evaluate the diagnostic utility and prognostic value of DSE in preoperative cardiac risk stratification in patients undergoing non-cardiac surgery at a tertiary care centre. Methods: This retrospective observational study included patients referred for preoperative cardiac evaluation who underwent DSE. Baseline clinical data, DSE findings, and perioperative outcomes were analyzed. Patients were followed for perioperative and short-term cardiac events. Results: A total of 200 patients were included. DSE was negative in 193 patients (96.5%), positive in 3 (1.5%), and inconclusive in 5 (2.5%). Target heart rate was achieved in 98.5% of patients. Among those undergoing further evaluation, significant coronary artery disease (CAD) was identified in a minority. Perioperative cardiac events were rare, with only one fatal NSTEMI reported. The negative predictive value of DSE approached 99%. Conclusion: DSE is a safe and highly reliable modality for preoperative cardiac risk assessment. A negative DSE effectively predicts low perioperative cardiac risk, helping avoid unnecessary invasive procedures.

Background: Hypertension in the elderly is associated with increased cardiovascular risk, and masked hypertension often remains undetected with office blood pressure (BP) measurements alone. This study aimed to evaluate the role of home BP monitoring in identifying hypertension patterns and predicting cardiovascular outcomes in treated elderly patients. Methods: This hospital-based observational study included 106 treated hypertensive patients aged ≥60 years attending OPD and IPD at RKDF Medical College Hospital and Research Centre. Demographic data, cardiovascular risk factors, and BP measurements were recorded. Patients were classified into controlled, masked, sustained, and white coat hypertension based on office and home BP readings. Participants were followed for cardiovascular outcomes, and hazard ratios were calculated to assess risk. Results: The majority of participants were aged 60–69 years, with male predominance (60.4%). Controlled hypertension was observed in 45.3% of patients, while masked hypertension was present in 28.3%. Home BP readings were higher than office measurements. Sedentary lifestyle (41.5%) and dyslipidemia (37.7%) were the most common risk factors. Patients with masked hypertension showed a significantly higher incidence of left ventricular hypertrophy (33.3% vs 12.5%, p=0.01) and coronary artery disease (26.7% vs 12.5%, p=0.04). Masked hypertension was associated with a two-fold increased risk of cardiovascular events (HR 2.05, p=0.01). Increasing home systolic and diastolic BP were significant predictors of cardiovascular risk. Conclusion: Home BP monitoring is essential for detecting masked hypertension and improving cardiovascular risk prediction in elderly hypertensive patients.

Introduction:  Acute myocardial infarction is a public health problem in developed and developing countries. Previously seen in older age group, now has become commoner in younger age groups also. Aims & Objectives:The primary objective of this study is to characterize the clinical presentation, cardiovascular risk factors profile and coronary angiographic patterns in young adults less than 40 years presenting with ST elevation Myocardial Infarction (MI).Materials and Methods: In the present study we are analysing 50 patients with ST elevation MI in a tertiary care hospital, demographic variables, angiographic profiles and outcomes.Results: In our study, there were 26 patients diagnosed with Anterior wall MI having LAD involvement. 13 patients with Inferior wall MI, with RCA as the culprit artery. 4 patients had double vessel disease with LCX and LAD involvement, and one patient had triple vessel disease. This infers that the Anterior wall MI is more common in young MI group (<40 years), Inferior wall MI being next common with few Lateral wall MI with LCX as culprit artery. In our study, there were 10 Diabetics, 12 Hypertensives, 21 Smokers, & 24 alcoholics with overlapping risk factors. Focused public health initiatives, early screening for cardiovascular risk factors, and tailored preventive strategies are imperative to curb the rising burden of premature coronary artery disease in this population. Larger, multicentre studies with long-term follow-up are warranted to further elucidate outcomes and refine management approaches for young patients with STEMI. Conclusion: Young STEMI patients constitute a significant and vulnerable subgroup with unique clinical and angiographic characteristics.