European Journal of Cardiovascular Medicine

COVID-19 has been declared a global pandemic by the World Health Organization and is responsible for hundreds of thousands of deaths worldwide. COVID-19 is caused by SARS-CoV-2, and common clinical symptoms include fever, cough, sore throat, headache, and fatigue. The cardiovascular system is affected in this infection, with complications including myocardial injury, myocarditis, acute myocardial infarction, heart failure, dysrhythmias, and venous thromboembolic events. Current therapies for COVID-19 may interact with cardiovascular medications. Myocardial injury is relatively common in patients with COVID-19, accounting for 7%-23% of cases, and is associated with a higher rate of morbidity and mortality [1]. In patients with COVID infection clinical suspicion is necessary to diagnose myocarditis as an important complication of this infection. Here we present a patient who developed shortness of breath and orthopnea following sore throat and myalgia and was eventually treated with a diagnosis of myocarditis and discharged from the hospital in relatively good general condition.

ackground: Diabetes is a major causative risk factor for the development of ACS & the adverse outcome after ACS. ‘Stress hyperglycaemia’ has been defined in different ways by various studies. Transient hyperglycaemia has been recognized as a noticeable feature in ACS and is related to stress (Lakhdar et al., 1984).[1] Glycosylated haemoglobin is thus useful to differentiate between stress hyperglycaemia diabetes mellitus. Glycosylated haemoglobin has more sensitivity and specificity for diagnosing diabetes in acute myocardial infarction patients, than admission hyperglycaemia

Background: The ECG remains the most immediately accessible and widely used diagnostic tool for guiding emergent treatment strategies. Coronary angiography is a widely used invasive examination which is considered the reference standard for assessing presence of stenosis in the coronary arteries. Objectives: To correlate findings of ECG and Coronary Angiography in identifying culprit artery among patients with acute ST Elevation Myocardial Infarction. Methods and Material: The study was undertaken among 100 Patients aged 18years and above presenting with symptoms suggestive of Acute Myocardial Infarction as a diagnostic accuracy study. Convenient sampling technique was used to include patients in the study. Results: Most of the study participants were in the age group of 46-60 years (44%) and males (75.0%). Hypertension (44%), Obesity (28%) and Diabetes (26%) were found to be the three most common comorbidities among the study participants. Chest pain (71%), profuse sweating (57%) and chest discomfort (44%) were the most common complaints. The mean duration of symptoms among all the patients was 75.65±45.0 mins. The sensitivity and specificity of ECG  in detecting LAD involvement is 71.8% and 72% respectively. The sensitivity and specificity of ECG in detecting RCA involvement is 71% and 94.2% respectively. Conclusion: ECG was found to have good accuracy in predicting the culprit artery involved in patient with ST elevation MI. The sensitivity of ECG was good in predicting all the three main arteries and an even higher specificity was noted in case of RCA

Introduction: Type 2 diabetes (T2D), a frequent comorbidity in AMI, has been associated to an increased risk of long-term in-hospital mortality and upcoming cardiovascular events. "Inflammation underlies both the complicated diseases diabetes mellitus and atherosclerosis. Acute myocardial infarction is really a risk factor for type 2 diabetes, which is assessed in a state of low-grade inflammation. Aims: To identify the “CRP level at the time of admission as a reliable indicator of hospital mortality and morbidity in both patients with and without diabetes mellitus who experienced an acute myocardial infarction Materials and Methods: The material for the present study was collected from patients who are admitted in Katihar Medical College and Hospital over a period of one and a half year from December 2020 to May 2022.100 Patients were included in this study. Result: This study found that diabetes patients with acute myocardial infarction had statistically significant higher admission CRP levels than non-diabetic patients . Patients with diabetes who had higher CRP levels had a greater incidence of death and morbidity when compared to non-diabetic patients. Conclusion: According to the results of this investigation, CRP is a potent predictor of hospital morbidity and mortality in both diabetes and nondiabetic individuals with acute myocardial infarction.

Background:  Dextrocardia is an uncommon congenital heart condition which occurs due to aberrant positioning of the heart in the right hemithorax. In the current case report, we describe a 69-yearold male who experienced retrosternal chest discomfort that spread to his right shoulder was diagnosed with dextrocardia with situs inversus. Due to this condition, a diagnostic challenge was encountered. Lead reversal on an electrocardiogram (ECG) showed features of dextrocardia with myocardial infarction (MI). A chest x-ray and an echocardiography also confirmed the diagnosis. After receiving successful coronary intervention, the patient was eventually discharged from the hospital.

Material & Methods: Study Design:  Case-control study. Study area: Department of General Medicine, Nimra Institute of Medical Sciences, Vijayawada. Andhra Pradesh. Study Period: April 2022 – March 2023. Study population:  Patients with acute myocardial infarction admitted in department of medicine. Sample size: Study consisted a total of 50 cases and 10 controls. Sampling Technique:  Simple random method. Study tools and Data collection procedure: 50 acute myocardial infarction cases and 10 healthy controls were selected. The subjects were informed about the nature and purpose of the study and consent was taken from subjects themselves or family members in case of unconscious patients. Patients presenting with chest pain suggestive of myocardial infarction, who showed E.C.G. evidence of acute infarction changes were assessed by detailed history and physical examination as outlined in proforma. The infarction was confirmed by elevated CPK/troponin levels. Serum magnesium is estimated within first 24 hours of chest pain. Serum magnesium estimated by Colorimetric method using calmagite. Clinical findings, and serum magnesium levels are used as parameters to assess the incidence of complications likes arrhythmias, left ventricular failure, cardiogenic shock, supraventricular arrhythmias. Bundle Branch Block, Hemi Block, AV Block and Mortality in patients with AMI. Results: There were more number of deaths in AMI patients with hypomagnesemia than in patients of AMI with normal serum magnesium levels. There is no statistically significant association of hypomagnesemia with death in cases of AMI as p value is 0.091. Conclusion: Prophylactic administration of the intravenous magnesium sulphate may be considered in all cases of Acute Myocardial infarction as an adjuvant to thrombolytic therapy and in patients not suitable for thrombolysis to prevent cardiac arrhythmias & reduce short term mortality irrespective of serum magnesium levels as it is safe and cheap.

Background: The apolipoprotein B (ApoB) is the main component of very low-density lipoproteins (VLDL), intermediate-density lipoproteins (IDL), low-density lipoproteins (LDL) and lipoprotein(a) (Lp(a)) particles. LDL contains variable quantities of cholesterol, but each lipoprotein contains a single ApoB protein, while Apolipoprotein A1 (ApoA1) is the main apolipoprotein incorporated into high‐density lipoprotein (HDL). It has a major role in reversing cholesterol flow and cellular cholesterol homeostasis once detected. Therefore, the ApoB/ApoA1 ratio reflects the cholesterol balance between atherogenic and anti-atherogenic lipoprotein particles. Aim: The aim of the study is to measure ApoB/ApoA1 ratio in patients with acute myocardial infarction. Methods: Total of 60 patients aged 18–80 years were included in the study. The plasma levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), apolipoprotein A1, ApoB protein, ApoB/ApoA1 ratio were determined after a 12 h fasting period. Results: Mean ApoB/ApoA1 ratio for our study was 0.87 with 60% of STEMI patients had ratio >0.8. In our study, 23.64% of patients had absolutely normal lipid profile with deranged ApoB/ApoA1 ratio. Conclusion: Despite normolipidemic, the subjects with the unfavourable ApoB/ApoA1 ratio had more atherogenic lipid profile and corelated its relationship with the severity of CAD.

Background: In the West, coronary heart disease, or CHD, is the main cause of mortality. Young people experiencing an acute myocardial infarction (AMI) is comparatively rare. Nevertheless, it remains a significant issue for both the patient and the attending physician. There are few studies of risk factors of coronary artery involvement in AMI in young adults, so the purpose of the present study is to identify the risk factors for acute myocardial infarction in rural India. Methods: This was an institute based Observational Cross Sectional Study, done at General Medicine Ward, Department of General Medicine, Burdwan Medical College and Hospital, West Bengal, India, from May 2020 to July 2021. Total 100 patients admitted with AMI during this period meeting the inclusion and exclusion criteria were included in this study. A Microsoft Excel spreadsheet containing the data was used for data entry, and SPSS (version 2710; SPSS Inc., Chicago, IL, USA) was used for analysis. Result: In the present study mean age of patients was 35.21 ±4.39 years, majority of patients belonged to age group of 36-40 years (56%). The mean BMI was 27.23 ±3.34 kg/m2. The most common presentation was chest pain (90%) followed by profuse sweating (65%), radiation to left shoulder/arm (45%), nausea/vomiting (40%), anxiety (38%), breathlessness (28%). Most common risk factor was smoking (85%) followed by hyperlipidemia (82%), family history of premature coronary artery disease (72%), hypertension (52%), sedentary lifestyle (42%), psychosocial stress (38%), obesity (16%) and diabetes mellitus (14%). Majority of the study subjects had more than 3 risk factors (64%), while 21% had 3 risk factors, 13% had two risk factors. Mean level of cardiac enzyme marker CKMB was 38.42 ±5.67 IU/L. Conclusion: Acute MI in young patients is becoming a rising problem in Indian subcontinent which is more common in men. Smoking was the most common risk factor of MI in them indicating atherosclerosis could be the commonest cause followed by dyslipidemia.

Background: High sensitive C reactive protein levels (hs-CRP), a classical sensitive systemic inflammatory marker, are associated with short term and long term mortality in patient with acute coronary syndrome (ACS). Aim: The aim of this study was to find out the correlation of hs-CRP with coronary artery disease severity assessed by SYNTAX score (SX score) in patients with acute myocardial infarction (AMI). Methods: This cross sectional study was conducted in the Department of Cardiology, National Heart Foundation Hospital & Research institute, Dhaka, over a period of one year from 01/01/22 to 31/12/22. A total of 165 patients with AMI who underwent coronary angiography (CAG) selected purposively were included after considering inclusion and exclusion criteria. Study population were categorized equally into 3 tertiles according to available hs-CRP values. 33% (n=55) patients were in group A and their hs-CRP level was ≤25.3 mg/L; 33%(n=55) patients were in group B and their hs-CRP range was 25.4-70.6 mg/L; 33% (n=55) were in group C and their hs-CRP level was ≥70.7 mg/L. Baseline characteristics, biochemical variables, left ventricular ejection fraction(LVEF) and coronary artery disease severity by SYNTAX score were then compared among three groups. Results: Patients with raised level of           lllhs-CRP (Group C tertile) had significantly higher SYNTAX score compared with other    two tertiles [mean (±SD) SYNTAX score was 9.0 ± 4.3; 16.2 ± 5.6; 29.7 ± 8.3 respectively; (p <0.05)]. Strong positive correlation (r=0.885) was found between hs-CRP and SYNTAX score, which was statistically significant (p ˂0.05). Logistic regression analysis showed that hs-CRP was independently associated with severity of coronary artery disease assessed by SYNTAX score (OR= 54.883, p ˂0.001). Conclusion:  hs-CRP was a significant independent predictor of coronary artery disease severity  assessed by SYNTAX score in patients presenting with AMI.

Background: Red cell distribution width  (RDW) is an important parameter  that has a critical  impact  on the severity of coronary artery disease,  especially  on that  of acute  myocardial  infarctionⁱ(AMI). Objective: study was to assess the correlation between red cell distribution width and left ventricular ejection fraction in patients presenting with acute myocardial infarction.  Methods: Study was conducted on 110 patients admitted at tertiary care centre with acute myocardial infarction satisfying inclusion criteria. Detailed history and clinical examination was done. RDW and other CBC parameters were calculated by an automatic blood counter and measurement of LVEF done by 2D-echocardiography. Results: Out of 110 patients of acute myocardial infarction 86 were male and 24 were female. Both RDW and LVEF are linked in patients of acute myocardial infarctions, as there was statistically significant correlation between high RDW and low LVEF.  Conclusions: It is observed that increase RDW and decrease LVEF were linked together which is statistically significant.

Introduction: Coronary artery disease (CAD) is one of the commonest causes of mortality and morbidity. The Fibrinogen/Albumin Ratio (FAR) is a newer marker of inflammation that has been shown to be a predictor of short-term prognosis in patients with acute myocardial infarction. Utility of FAR in predicting angiographic severity of CAD and clinical outcomes is not yet clear in Indian patients.  Objective: To study the role of fibrinogen-to-albumin ratio (FAR) as predictor of the angiographic severity of the coronary artery disease, and the short-term prognosis in the patients undergoing coronary angiography. Material and Methods: The present single-centre, prospective, observational study conducted in the Department of Cardiology at a tertiary care teaching institute in north India. A detailed history, physical examination and all routine investigations along with serum albumin, fibrinogen, ECG & 2-D Echo were done for all the patients. Samples were drawn at admission, before angiography. All the patients underwent clinically indicated invasive coronary angiography. SYNTAX SCORE was calculated using an online SYNTAX SCORE calculator. Results: Out of the 237 patients for final analysis, the majority (81.4%) were male. The mean age of the patients was 57 years. The mean fibrinogen level was 397.97 mg/dl, the mean serum albumin level was 4.05 g/dl and the mean FAR was 101.07 mg/g. with FAR below it was considered as low FAR and above it was considered as high FAR. The mean CAG Syntax score was 22.02. Majority of patients (58.6%) had acute coronary syndrome (ACS), while remaining had stable coronary artery disease. Two FAR groups were found to have comparable proportions of patients across the two Syntax score groups (low SS < 23, high SS > 23). The p-value for the correlation between FAR and Syntax Score was not significant (p=0.941). Conclusion: FAR was not found to be associated with CAD severity among Indian patients with stable CAD and ACS in the present study. This study didn’t find any correlation between the FAR and short-term prognosis.

Introduction:  AMI is the leading cause of death for both men and women all over the world. Acute myocardial infarction is myocardial necrosis resulting from acute obstruction of coronary artery. Calcium ions are involved in myocardial contraction, and during acute myocardial infarction. The disruption of blood flow to the heart muscle can lead to an imbalance in calcium levels. This disruption can cause calcium overload with myocardial cells, leading to cellular injury and dysfunction. Magnesium has properties of myocardial cryoprotection, the pathophysiological explanations of which in açute myocardial infarction include prevention of arrythmia, antiplatelet effect, prevention of reperfusion injury and coronary vasodilation. Increased serum uric acid (SUA) levels have been associated with various pathologic processes such as increased oxidative stress, inflammation and endothelial dysfunction. Troponin I is highly specific to cardiac muscle so its presence in the blood stream is a reliable indicator of heart muscle damage. The Elevation in troponin I levels is used as a diagnostic marker for AMI.

Material and Methods:A comparative and cross-sectional study was conducted in the Department of Biochemistry in Rangaraya Medical College, Kakinada over a period of 4 months. Sampling Type: Casual sampling of newly diagnosed AMI patients attending the OPD. Controls are recruited from healthy individuals attending the OPD for health checkup. Sample Size: 50 newly diagnosed AMI patients constitute group 1, 50 age and sex matched healthy individuals in group 2. Results: The Group 1 has a higher mean age (54.36±6.70 years) compared to Group 2 (51.3±7.98 years), suggesting that on average, participants in Group 1 are older than those in Group 2. The higher mean calcium level in Group 2 (9.276±1.24 mg/dl) compared to Group 1 (8.548±1.73 mg/dl) suggests that, on average, participants in Group 2 have higher calcium levels than those in Group 1. Comparing the two groups:- Group 2 has a higher mean magnesium level (2.062 mg/dl) compared to Group 1 (1.892 mg/dl). The standard deviation for magnesium levels is smaller in Group 2 (0.41) compared to Group 1 (0.71), indicating that magnesium levels in Group 2 are less variable around the mean compared to Group 1. Group 1 has a mean uric acid level of 7.824 mg/dl with a standard deviation of 5.95 mg/dl. Group 2 has a mean uric acid level of 6.188 mg/dl with a standard deviation of 2.10 mg/dl. Group 1 has a mean Troponin I level of 4463 pg/ml with a standard deviation of 5226.92 pg/ml. Group 2 has a mean Troponin I level of 10.048 pg/ml with a standard deviation of 14.03 pg/ml. Conclusion: Acute MI is the 3rd largest cause of death in the population. If untreated it causes necrosis of the myocardium and finally death of the patient. Magnesium has cytoprotective properties, anti-platelet effect, prevents arrhythmias and reperfusion injury and coronary vasodilation. So it should be estimated. Calcium ions are involved in myocardial contraction. It plays a role in coagulation cascade. It forms blood clots that obstruct blood flow so medications targeting calcium channel to reduce myocardial oxygen load and improve coronary circulation. Uric acid may be a marker for increased cardiovascular risk. Troponin I is highly specific and diagnostic of acute MI.

Information about the impact of gender on the prognosis of acute myocardial infarction-cardiogenic shock (AMI-CS) in young adults is scarce. Techniques: A cohort of AMI-CS admissions between the ages of 18 and 55 that occurred between 2018 and 2023 was identified retrospectively using the National Inpatient Sample. It was determined which procedures were used: non-cardiac interventions, mechanical circulatory support (MCS), percutaneous coronary intervention (PCI), and coronary angiography. The use of cardiovascular interventions, the duration of stay, hospitalization expenses, and in-hospital death were all relevant outcomes. Results: There were 90,648 AMI-CS admissions for patients under the age of 55 in total, with 26% being female. Men's prevalence of CS increased from 2.2% in 2000 to 4.8% in 2017, whereas women's rates decreased from 2.6% in 2000 to 4.0% in 2017 (p<0.001). Women, had poorer socioeconomic position than men (all p<0.001). Acute non-cardiac organ failure, cardiac arrest, elevated ST-segment appearance, and PCI rates were all lower in women (all p<0.001). They also received less frequent coronary angiography (78.3% vs. 81.4%), early coronary angiography (49.2% vs. 54.1%), PCI (59.2% vs. 64.0%), and MCS (50.3% vs. 59.2%). An independent predictor of in-hospital death was female sex mortality (23.0% vs. 21.7%; adjusted odds ratio 1.11 [95% confidence interval 1.07–1.16]; p<0.001). Women had lower hospitalization costs (156,372±198,452 vs. 167,669±208,577; p<0.001) but comparable lengths of stay compared to men. Conclusions: In young AMI-CS admissions, women are treated less aggressively and experience higher in-hospital mortality than men.

Background: Myocardial necrosis starts rapidly after coronary occlusion, usually before reperfusion can be achieved. The loss of viable myocardium initiates a process of adverse left-ventricular remodeling leading to heart failure. Cardiac transfer of Bone marrow and human peripheral blood mononuclear cells (PBMNCs) -derived stem cells can have a favorable impact in patients with myocardial infarction. Objectives: To study transplantation of non-expanded peripheral blood mononuclear cells (PBMNCs) in patients with Myocardial infarction with its safety and feasibility. Methods: It is ist prospective pilot study from the region with six months of follow-up. 10 Patients of ST-elevation acute anterior wall Myocardial infarction with occlusion of left anterior descending were taken for Echocardiography (2 blind operators) before coronary intervention. Percutaneous coronary intervention of left anterior descending (LAD) by drug eluting stent followed by intracoronary infusion of PBMNCs was done. 10 patients of acute anterior wall myocardial infarction were taken as control in whom only LAD stenting was done. PBMNCs suspension was infused distally to the occluding balloon through the central port of the balloon catheter. This maneuver was repeated 4 times to accommodate infusion of the total 20-ml cell suspension, interrupted by 2-3 minutes of reflow by deflating the balloon to minimize extensive ischemia. Left ventricular functions were compared at base line and after six months of follow up by blinded operators. Results: Demographic variables, clinical variables and left ventricular systolic functions at base line were comparable. After Six months of follow up in both case and control group there was improvement in left ventricular functions. But there was more improvement in Left ventricular functions in cases where intracoronary stem cell therapy was given in addition to LAD stenting as compared to control group. Increase in Ejection fraction and wall motion score index was statistically significant (P-value <0.05) in stem cell therapy group. Conclusion: Intracoronary PBMNCs infusion is a less invasive, more feasible, safer and a novel therapy for acute myocardial infarction patients who have depressed cardiac function. It causes significant improvement in parameters of left ventricular functions especially Ejection fraction and wall motion score index which are most important prognostic factor in myocardial infarction patients.

Introduction: Study comparatively evaluated the effect of metoprolol (intravenous followed by oral) treatment along with control drug (isosorbide dinitrate and diazepam) in a prospective randomized control trial manner. Here, patients were stratified according to age, infarct size, infarction type and type of ventricular arrhythmias before administrations of drug intravenous and oral metoprolol and others for total 70 patients. All patients were studied up to 365 days here and no death recorded in metoprolol therapy while 37% death occurred in control drug group. Thus, sufficient improvement in reduction of cardiac deaths recorded via metoprolol as compared to (Control) isosorbide dinitrate and diazepam (37%). Not only is that improvement in the reduction of chest pain, better controlled heart rate with reduction in the incidence of post-infarction arrhythmias, controlled systolic blood pressure, better reduction and limitation of infarct size , better electrocardiographic findings and reduced serum CPK-MB value also been recorded. In conclusion early administration of metoprolol and treatment in AMI improves the health (cardiac) status of patients suffering from myocardial infarction and thereby, significant reduction in death rate, reinfarction did not occur in metoprolol treated group as compared to 17.1% cases had reinfarction in control group.

According to the present statistics, end of this decade the non-communicable disease will cause 70% of deaths in developing countries. The use of thrombolytic strategies like Streptokinase has been reason for reduction in mortality and Reperfusion arrhythmias have been considered successful markers of reperfusion. The prevalence of reperfusion arrhythmias during and within 48 hours of intravenous streptokinase therapy, to assess the prognosis of myocardial infarction (MI) secondary to thrombolytic therapy, and find if the reperfusion arrhythmias are non-invasive markers of successful thrombolysis using the electrocardiogram. Methodology: 100 Patients admitted to NRI Institute of Medical Sciences, Sangivalsa, tertiary care, teaching hospital in South India, with features suggestive of acute myocardial infarction who have undergone thrombolytic therapy are selected for the study. These 100 patients were divided into 5 age groups as 35-45,46-55, 56-65,66-75 and 76-85years. Each age group was further divided into male and female groups. Adult patients of both sexes and different age groups after obtaining formal consent from the patients or relatives were included. Reperfusion arrhythmias during and within 48 hours of thrombolytic therapy using electrocardiography (ECG) were assessed. Results: Among all types of myocardial infractions (MI), Reperfusion Arrhythmias are more prevalent in anterior wall MI (43%) and less observed in inferoposterior wall MI (7%). The prevalence of the age and sex has been depicted. Maximum incidence of reperfusion arrhythmias was present in age group of 46-55 years i.e 28% followed by 66-75 i.e 26%,56-65-16%,35-45 and 76-85-15%. Among males and females, 57% of males and 43% of females showed maximum incidence. Results showed that there was no significant relationship between age and gender with reperfusion arrhythmias.  There was a significant relationship observed between reperfusion arrhythmias and Diabetes (p=0.023). Incidence with hypertension (HTN) was 53%, and although hypertension was high in MI, the p-value was not significant between reperfusion arrhythmias and hypertension. Reperfusion arrhythmias incidence in risk factors such as alcoholics and smokers which was not significant, suggests that there was no statistical significance between these risk factors and arrhythmias. Observations drawn from results suggest that window period hospital presentation and types of myocardial infarction do not influence the occurrence of reperfusion arrhythmias (P=0.778) and there was a significant relation between reperfusion arrhythmias and survival of the effected patients of the study group (p=0.014).

Conclusion:

• Arrhythmias are most frequently seen during or following thrombolysis of Acute MI. Mortality and morbidity of Acute MI can be modified by early recognition and management of these arrhythmias.
• Acute MI is a major cause of hospitalization in the elderly and is associated with higher mortality and morbidity, most frequently seen between the 4^th to 7^th decades, with male preponderance.
• Mortality was high in Anterior wall MI, Ant Inf wall MI, which were associated with Ventricular Tachycardia, Ventricular Fibrillation, showing 100% mortality which must be intervened immediately.
• Reperfusion Arrhythmias are not an event of serious concern as they are usually well-tolerated and are amenable to treatment. Early streptokinase therapy has a favorable impact on mortality in MI and hence should be tried in all the Acute MI patients who do not have contraindications for streptokinase therapy.

Introduction: Acute myocardial infarction is one of the most common causes of hospitalization as well as one of the most common causes of death. Up to three million people worldwide are afflicted with the illness, which has an incidence of 64.37/1000 in India and a very high chance of passing away in the initial hours following the onset of symptoms. Aims: To study the prevalence and pattern of dyselectrolytemia in patients of acute MI (both STEMI and NSTEMI). To study effect of dyselectrolytemia towards clinical outcome in patients with Acute MI during early acute phase. Materials & Methods: The study design was prospective case control study, from July 2022 to December 2023, place of study was Katihar Medical College and total sample size was 60 Result: In our study, 6 (10.0%) patients had Accelerated Hypertension, 1 (1.7%) patient had Bradycardia, 3 (5.0%) patients had Bradycardia With Hypotension, 2 (3.3%) patients had Cardiogenic Shock, 2 (3.3%) patients had Heart Block, 7 (11.7%) patients had Hypotension 6 (10.0%) patients had Pulmonary Edema, 3 (5.0%) patients had Pulmonary Edema With VT and 5 (8.3%) patients had VT complications. The value of z is 5.318. The value of p is <.00001. The result is significant at p < .05. Conclusion: We concluded that AMI frequently have electrolyte abnormalities, especially those affecting potassium and sodium, which can have a negative impact on clinical outcomes. For patients to have a better prognosis, these abnormalities must be identified early and managed.

Introduction: Acute myocardial infarction (AMI), commonly known as a heart attack is a leading cause of mortality in developed countries, posing a significant threat to public health. “Over a million sufferers may travel there every year, and the condition affects over three million people worldwide. Aims: The study to aim the prognostic significance of white blood cell count and plasma glucose level at admission in acute ST elevation myocardial infarction terms of in hospital mortality. Materials and method: The present study was a Cross-Sectional Study. This Study was conducted from July 2022 to December 2023 at Katihar Medical College and Hospital in Bihar. Total 80 patients were included in this study.  Result: In our study, 49 (61.3%) patients had Diabetics. The value of z is 2.846. The value of p is .00438. The result is significant at p < .05. In our study, 61 (76.2%) patients had Low RBS and 19 (23.7%) patients had High RBS of Random Blood sugar of patients in High RBS (>200) and Low RBS (<180). The value of z is 6.6408. The value of p is < .00001. The result is significant at p < .05. Conclusion: In conclusion, elevated plasma glucose and white blood cell (WBC) counts at the time of admission in patients with acute myocardial infarction (AMI) are significant prognostic indicators. Both hyperglycemia and leukocytosis are associated with increased in-hospital complications, higher mortality rates, and poorer long-term outcomes. These findings highlight the importance of early detection and management of these markers in AMI patients, as they can provide valuable insight into the severity of the condition and guide treatment strategies to improve patient outcomes.

Background: To improve the electrocardiographic diagnosis of acute myocardial infarction in patients with left bundle branch block will help to reduce many false activations of the protocols for emergent reperfusion and will help to provide timely reperfusion to those patients who are truly experiencing an acute myocardial infarction Methods: Adult patients referred for suspected myocardial infarction because of new or presumed new Left bundle branch block (LBBB) with available Electrocardiography (ECG) recorded at the first medical contact were included in this study.   Results: A total of 39 patients were included in this study. Mean age was 56.2 years, 23 were male (59%). The patients presented with symptoms of chest pain (48.7%), dyspnoea (17.9%) and palpitations (15.4%). The following commodities were noted, diabetes in 51.3 % and hypertension in 43.6%. Median troponin I was 2197 pg/mL. Barcelona criteria had a sensitivity of 73 % and modified Sgarbossa had a sensitivity of 64%. Both the criteria had specificity of 100%. Conclusions: Barcelona criteria significantly improved the diagnosis of Acute myocardial infarction (AMI) as compared with previous ECG rules, achieving a diagnostic performance for AMI similar to that of ECG in patients without LBBB. The high specificity of the algorithm was confirmed in a large and heterogeneous control group of patients without suspected AMI.

Objective: This study is aimed to assess the coronary sinus blood flow by transthoracic echocardiography in acute MI patients undergoing coronary angiography and comparing the coronary sinus flow pre and post percutaneous coronary intervention. Methods: The present hospital based prospective cross sectional descriptive study was conducted at KAHER University Hospital, Belgaum from January 2023 to June 2024 among 150 adult patients with acute coronary syndrome. Details on demographics, patient characteristics, laboratory parameters were recorded. Echocardiography parameters taken on admission were compared with the parameters post thrombolysis and post revascularization and was correlated with the severity of CAD and the success of revascularization Result: most of the patients were males. The patient population has a mean age of 60 years with a standard deviation of 11.29 years. The average Body Mass Index (BMI) is 27.61, suggesting that the population is, on average, slightly overweight, with a standard deviation of 4.68. The average diameter of the coronary sinus (CS) is 0.85 cm, with a standard deviation of 0.2 cm. Coronary Sinus Blood Flow (CSBF) per beat has a mean of 3.03 mL, with a standard deviation of 1.52 ml. On admission, the mean CSBF per minute is 218.63 mL, with a standard deviation of 93.64 mL. After Percutaneous Coronary Intervention (PCI), the mean CSBF significantly increases to 372.05 mL per minute, with a standard deviation of 126.15 ml, reflecting the effectiveness of PCI in improving coronary blood flow in this patient group. Overall, these results demonstrate that PCI significantly improves coronary blood flow in patients across all these categories, with the most substantial increases observed in those with STEMI-AWMI in the current study. Conclusion: Non-invasive evaluation of CSBF using transthoracic echocardiography is technically feasible in all patients undergoing PCI.It is a potentially simple, repeatable, cost-effective, non-cumbersome imaging modality for the assessment of CSBF in patients with CAD, and especially for those with AWMI. It can also be used to assess the effectiveness of treatment in patients with CAD. Results reflect hemodynamically significant changes in total coronary blood flow.

Background: Acute myocardial infarction has been reported to have poor long-term outcome in young adults. Hence, identifying the risk factors is necessary for primary and secondary prevention. This study was done to identify the risk factors for young myocardial infarction. Materials and Methods: 86 patients of myocardial infarction admitted at IGMC Shimla were included in the study and their demographic profile and risk factors were studied followed by coronary angiography. Observations: Out of 86 patients studied, maximum number of patients (53.48%) were in age group of 40-45 years with mean age of 38.4 years. 89.5% patients were male. ST segment elevation myocardial infarction (72%) was more commonly observed on ECG. Anterior wall and Anterolateral wall were the most common areas involved with prevalence of 35.4% and 30.6%, respectively. Smoking was the most common risk factor present in 93.02% cases. Hyperhomocysteinemia was present in 84.88% patients while 82.55% patients had ratio of ApoB/ApoA1 > 0.8. Diabetes mellitus and hypertension were present in 36.04% and 26.74% patients, respectively. Most common lipid abnormality observed was raised LDL followed by low HDL. Most common abnormality seen on coronary angiography was single vessel disease, seen in 62.71% patients. Conclusion: Acute myocardial infarction in young patients is more common in men in the Sub-Himalayan region. Smoking is the most common risk factor. ST elevated myocardial infarction with anterior wall involvement is the most common presentation. Single vessel disease is most commonly seen.

Acute myocardial infarction (AMI) in young patients is less common entity, but the incidence has increased over years past at younger ages, likely due to the presence of multiple risk factors. We present a of ST-elevation AMI (STEMI) in a young female. A 38-year-old female was transferred to our hospital due to severe chest pain. An electrocardiogram revealed ST elevation in lead V1, V2, V3, V4, V5, V6 with reciprocal depression in lead III and aVF. An emergency coronary angiogram was performed, revealing a 100% occlusion of mid left anterior descending (LAD) and we established a diagnosis of STEMI. Thrombo-suction was done and stented with third generation drug eluting stent. Afterwards, the patient was discharged the next day. In this case, a combination of atherosclerotic plaque rupture and stress from surgical trauma might lead to this atypical event.

Background: Acute Myocardial infarction (AMI) causes reduction in cardiac function and is one of major cause of death world-wide. The degree of myocardial damage following myocardial infarction is the key predictor of immediate as well as long term reduction in cardiac function and other complications. The serum CK- MB (Creatine Kinase-MB) levels are useful for assessing prognosis after AMI, the validity of the test goes down after 36 hours due to sudden fall in levels.Serum C-Reactive Protein (CRP), an acute phase protein, also increases during myocardial infarction in proportion to the degree of inflammation. The inflammatory process following myocardial infarction is a key role in determining the real damage to the myocardium following infarction. In this study, we made an attempt to find the correlation between serum CRP levels with CK-MB and left ventricular ejection fraction (LVEF) to assess if serum CRP levels could be used as a proxy to CK-MB levels for the prediction of inflammation and infarct extent, thereby having a reliable prognostication marker after 48 hours. Methods: 55 Patients diagnosed with acute myocardial infarction in a tertiary care centre were enrolled in the study. Serum CRP levels were measured and its correlation with Serum CK-MB levels and left ventricular ejection fraction were studied. Results: The Serum CRP levels were showing significant positive correlation with serum CK-MB levels and significant negative correlation with Left ventricular ejection fraction. Conclusions: The magnitude of elevation of CRP, the marker of inflammation in circulation correlates with the extent of myocardial injury following infarction showed significant positive correlation with CK-MB levels and a significant negative correlation with LVEF. So it could be used to predict the functional status of myocardium following acute MI. So the serum CRP can be used as an independent and more comprehensiveprognostic marker, like CK-MB and LVEF

Background: Acute Myocardial Infarction (AMI) is a leading cause of morbidity and mortality globally, with arrhythmias representing a frequent and significant complication. These arrhythmias, which can range from benign to life-threatening, are closely associated with the severity of myocardial injury and contribute to poor short- and long-term outcomes. This prospective observational study aimed to investigate the incidence, types, and outcomes of arrhythmias in patients with AMI admitted to the intensive coronary care unit at SVRRGGH, Tirupati. A cohort of 100 patients was assessed based on clinical features, ECG evidence, blood biomarkers, and imaging. The study found that the majority of patients were aged 41-70 years, with a significant male predominance (83%). Lifestyle factors such as smoking and alcohol use were common, and hypertension and diabetes were prevalent comorbidities. The most common type of myocardial infarction was Inferior Wall Myocardial Infarction (INFWMI). Arrhythmias, particularly ventricular premature contractions (VPCs), were observed in a significant number of patients, with spontaneous resolution noted in some cases. The study highlighted the relationship between the location of the myocardial infarction and the occurrence of specific arrhythmias, with no significant correlation found between MI type and mortality. Additionally, factors such as age, gender, and comorbidities influenced arrhythmic patterns and outcomes. These findings suggest that arrhythmias in AMI patients can often resolve spontaneously but require careful monitoring and timely intervention. The study underscores the importance of personalized treatment strategies and further research to refine management techniques and improve patient outcomes, particularly for those with high-risk factors such as comorbidities and lifestyle behaviors.

Background: Acute Myocardial Infarction (AMI) remains a major global health burden, with early risk stratification playing a critical role in optimizing patient outcomes. Admission hyperglycemia in non-diabetic individuals has emerged as a potential prognostic marker, though its clinical implications remain unclear. Objectives: This study aims to evaluate the prognostic significance of admission hyperglycemia in non-diabetic patients with AMI, assessing its impact on in-hospital mortality and major adverse cardiac events (MACE). Methods: An observational study was conducted at a tertiary care hospital over 24 months, enrolling 260 non-diabetic patients with AMI. Admission blood glucose levels were measured, with hyperglycemia defined as ≥140 mg/dL. Patients were categorized into normoglycemia and hyperglycemia groups. Baseline characteristics, inflammatory markers, cardiac function, and clinical outcomes were analyzed. Statistical comparisons were performed using t-tests, chi-square tests, and logistic regression analysis. Results: The hyperglycemia group had significantly higher levels of inflammatory markers (C-reactive protein and white blood cell count) and greater myocardial injury (elevated troponin I and CK-MB) compared to the normoglycemia group (p < 0.05). Left ventricular ejection fraction was significantly lower in hyperglycemic patients (45.8% vs. 51.4%, p < 0.001). In-hospital mortality was notably higher in the hyperglycemia group (16.9% vs. 6.2%, p = 0.009), along with an increased incidence of heart failure, arrhythmias, cardiogenic shock, and reinfarction (p < 0.05 for all). Patients with hyperglycemia also had a longer hospital stay (7.3 ± 3.2 days vs. 5.7 ± 2.1 days, p = 0.004). Conclusion: Admission hyperglycemia in non-diabetic AMI patients is associated with increased myocardial injury, a heightened inflammatory response, and poorer clinical outcomes, including higher in-hospital mortality and MACE. These findings highlight the need for early recognition and potential interventions targeting stress hyperglycemia in this patient population.

Introduction: The study examines the impact of myocardial blush grade on survival after primary percutaneous coronary intervention (PCI) in a high-risk AMI cohort undergoing mechanical reperfusion therapy at a tertiary referral center. Despite restoration of TIMI-3 flow, myocardial recovery is often suboptimal, leading to considerable mortality in high-risk patients. Aims: We sought to evaluate and validate the ability of the angiographic myocardial blush grade to risk stratify patients after successful angioplasty in acute myocardial infarction (AMI). Materials and methods: This was a quantitative, cohort study (observational) conducted in the Department of Cardiology at Burdwan Medical College and Hospital, Bardhaman, West Bengal 713104. The study was carried out over a duration of one year and included a total sample size of 100 participants. Result: Stent implantation was more common in the Final Blush 3 group (70%) compared to the Final Blush 0 to 2 group (54%), with a statistically significant difference (p = 0.03). Balloon angioplasty only was more frequently performed in the Final Blush 0 to 2 group (48%) compared to the Final Blush 3 group (28%), with a significant difference (p = 0.02). Conclusion: The study found no significant differences in clinical features between two groups with different myocardial blush grades. However, significant differences were observed in infarct territory, with more involvement in the Final Blush 0 to 2 group and more involvement in the Final Blush 3 group. Age, gender, and angiographic measurements showed no significant difference between the groups.

Background: The electrocardiogram remains a crucial tool in the identification and management of acute myocardial infarction. Acute risk stratification in myocardial infarction is still based on simple clinical parameters, laboratory markers and 12 lead electrocardiography. The electrocardiogram has been a preliminary screening and one of the most useful diagnostic investigations in myocardial infarction. This study evaluates the role of electrocardiography (ECG) in identifying the culprit vessel in acute ST-elevation myocardial infarction (STEMI) and correlates it with coronary angiography. ECG remains a crucial tool for early diagnosis, risk stratification, and guiding revascularization decisions by analyzing ST-segment elevation patterns and infarct-related arteries. Aim: To determine the culprit artery in the case of acute-myocardial infarction with electrocardiogram and to compare with coronary angiogram. Material and methods: This prospective observational study analyzed 50 acute myocardial infarction (AMI) cases over two years. Patients with chest pain >30 minutes and ST elevation on ECG who underwent coronary angiography within seven days were included. Exclusions were prior MI, CABG, congenital heart disease, LVH, LBBB, or Prinzmetal angina. ECG and cardiac enzyme tests (CK, CK-MB, troponins) were performed, and AMI cases were classified as anterior or inferior wall infarctions. Culprit vessels were identified via ECG and angiography. Data were analyzed using SPSS 23, with χ2 tests and a significance threshold of p<0.05. Sensitivity and specificity were also calculated. Results: The study assesses ECG parameters for occlusion site identification. ST elevation in V1 >2.5mm and aVR showed high specificity for proximal S1 occlusions. Q wave in aVL had 100% sensitivity for proximal D1. Distal S1 and D1 occlusions showed strong diagnostic markers, emphasizing ECG’s role in precise occlusion localization. Conclusion: Proximal LAD occlusion in anterior MI causes severe myocardial damage, while grade III ischemia or ST depression in V4–V6 in inferior MI indicates high-risk multivessel disease. Early ECG recognition is crucial for risk assessment and timely intervention.

Introduction: Cardiovascular diseases are the leading global cause of mortality, accounting for 31% of deaths, and AMI is responsible for 85% of fatalities. Acute myocardial infarction (AMI) in very young individuals is an emerging clinical concern with distinct risk factor profiles and presentations compared to older patients. This study aimed to compare the clinical characteristics and risk factor profile between very young (≤30 years) and older (≥50 years) patients presenting with first acute MI. Methods: This cross-sectional observational study was conducted Department of Cardiology of Dhaka Medical College & Hospital, Sir Salimullah Medical College & Mitford Hospital, National Institute of Cardiovascular Diseases (NICVD), Bangladesh Specialized Hospital (BSH), Dhaka, Bangladesh. This study was carried out from July 2022 to December 2023. In this study, we included 160 patients and divided them into two equal groups: Group I (very young, n = 80) and Group II (older, n = 80). Result: Males predominated in both groups with no significant difference in gender distribution (p = 0.137). Older patients had significantly higher frequencies of epigastric pain and nausea/vomiting (p < 0.05). Blood pressures were significantly higher in the older Group (SBP: p = 0.004, DBP: p = 0.029). Younger patients had a significantly higher prevalence of smoking, dyslipidemia, obesity, positive family history of CAD, and substance abuse (p < 0.05), while hypertension and diabetes mellitus were more common in older patients (p < 0.05). Cardiogenic shock and complete heart block were more frequent in younger patients, with cardiogenic shock reaching statistical significance (p = 0.008). Independent predictors for AMI in the very young included smoking (OR = 12.0), dyslipidemia (OR = 8.89), obesity (OR = 21.89), family history of CAD (OR = 17.69), substance abuse (OR = 4.34), and elevated CRP levels (OR = 1.08). In older patients, diabetes mellitus (OR = 12.69), hypertension (OR = 26.62), and low vitamin D levels (OR = 1.11) were significant predictors (all p < 0.001). Conclusion: This study showed that very young patients exhibited more typical clinical features, higher complication rates, and a greater prevalence of certain risk factors such as smoking, obesity, dyslipidemia, and family history of CAD. But older patients had more atypical symptoms with predominant conventional risk factors.

Aim:  Aim of this study was to evaluate prescription patterns of drugs for prophylaxis of secondary ischaemic events in patients surviving acute myocardial infarction (MI).  Methodology: This cross-sectional, observational study was conducted at Department of Pharmacology, in association with Department of Cardiology, a tertiary care teaching hospital Santosh Medical College & Hospital, Ghaziabad. Study population consisted of adult patients of both sex who had been treated for myocardial infarction and were discharged from hospital.  Results: Out of 101 STEMI diagnosed patients, 66 were males and 35 were females. Maximum patients belonged to age group (60-69 yrs) . Antiplatelet and hypolipidemic drugs were prescribed to every patient. Atorvastatin was prescribed to 100% patients; while dual antiplatelet drugs (Aspirin and Clopidogrel) used in 99% patients. Among antianginal drugs, Isosorbide dinitrate (ISDN) was most commonly prescribed drug in 66 patients (65.34%), followed by Nitroglycerin (NTG) in 62 patients (61.38%). While among antihypertensive drugs beta blockers (Metoprolol) was maximally prescribed, in 64 patients (63.36%), followed by ACE inhibitors (Ramipril) in 32 patients (31.68%), respectively. Patients were advised about lifestyle modifications like smoking cessation, avoidance of environmental tobacco smoke, physical activity for at least 30 minutes for seven days or minimum five days per week. Further, patients were advised to visit for first follow up after seven days.  Conclusion: Findings of our study are in accordance with AHA and ESC 2018 guidelines

Background: Acute myocardial infarction (AMI) among young adults is increasingly prevalent, posing unique diagnostic, therapeutic, and preventive challenges due to distinct risk profiles. This study aimed to evaluate risk factors and management challenges specific to AMI patients aged 18–45 years. Methods: A prospective observational study involving 150 young adults admitted with AMI was conducted. Data collected included demographic information, clinical presentations, cardiovascular risk factors, management approaches, and encountered challenges. Clinical evaluation involved standard ECG, cardiac biomarkers, echocardiography, and coronary angiography. Statistical analysis was performed using SPSS software (version 25), employing Chi-square tests, independent t-tests, and multivariate logistic regression. Results: The majority of participants were males (82%), and prevalent risk factors included smoking (64.7%), dyslipidemia (42%), obesity (37.3%), and psychosocial stress (26.7%). Illicit drug use was noted in 11.3% of cases. Management primarily involved primary PCI (58%). Significant challenges were delayed hospital presentation (34%), atypical symptomatology leading to diagnostic delays (20.7%), medication non-adherence (18%), and referral difficulties (16.7%). Conclusion: AMI in young adults predominantly arises from modifiable lifestyle and psychosocial risk factors, compounded by systemic management challenges. Emphasizing preventive strategies, early intervention, and public awareness campaigns is crucial to reduce cardiovascular morbidity in this demographic.

Background: Ischemic heart disease is one of main causes of death in industrialized countries. PCI is efficient therapeutic approach. Objective: to evaluate whether remote ischemic post-conditioning could reduce enzymatic infarct size in patients with acute ST-segment elevation myocardial infarction undergoing PCI. Methods: Study will be conducted in 100 patients presenting with 6-12hrs of onset of chest pain and diagnosed to be having acute STEMI in SSIMS&RC, Davanagere. All patients are prepared with thigh-sized limb cuff before arterial puncture. In active treatment group, protocol will be started with thrombolysis/balloon inflation, whichever occurred first, lower limb will be exposed to 3 cycles of ischemia/reperfusion, each obtained by 5min cuff inflation at 200mmHg, followed by 5min complete deflation. End point of study will be enzymatic infarct size assessed by AUC of CK-MB release. Blood samples will be collected before PCI, every 6hrs during first 48h and at 72hrs. Result: Among cases 28 patients (56%) had blush grade 3, 15patients (30%) had blush grade 2 and 7patients (14%) had blush grade 1 respectively after PCI among control group 10patients (20%) had blush grade 3, 20 patients (40%) had blush grade 2 and 20patients (40%) had blush grade 1 respectively after PCI. There was significant statistical difference between two groups. The AUC of serum CK release during the first 72 hours of reperfusion was significantly reduced in postconditioned group compared with control group. Conclusion: Remote post conditioning of lower limb significantly improves blush grading and enzymatic infarct size reduction with a trend towards significant reduction of mean ST segment deviation. Hence RIPC reduces enzymatic infarct size obtaining beneficial effect.

Introduction: Acute myocardial infarction (AMI), commonly known as a heart attack, remains a significant global health burden and one of the leading causes of mortality worldwide. AIM: Study of relationship of Serum Ferritin in Acute Myocardial Infarction. Methodology: This hospital-based observational case-control study was conducted in the Department of Medicine at Mahatma Gandhi Medical College and Hospital, Jaipur, a tertiary care centre, over a period of 18 months from April 2023 to September 2024. Result: The study found significantly elevated serum ferritin levels (≥200 μg/L) in 63.8% of MI patients versus 18.2% of non-MI individuals (p < 0.0001), highlighting its strong association with myocardial infarction. Serum ferritin also showed strong positive correlations with Troponin-I, CK-MB, and hs-CRP, supporting its role as an inflammatory marker in acute myocardial injury. Conclusion: Serum ferritin levels were significantly elevated in acute MI patients and showed strong correlations with key cardiac biomarkers, indicating its role in myocardial injury and inflammation. These findings support ferritin’s potential as a reliable adjunctive biomarker for MI diagnosis and risk assessment.

Background: Acute coronary syndromes (ACS) are an emerging epidemic in India, driven by the rising prevalence of risk factors such as obesity, diabetes, hypertension, and dyslipidemia. Elevated red cell distribution width (RDW) has been identified as a strong predictor of mortality and major adverse cardiac events (MACE) in patients with acute myocardial infarction. Objectives: To determine RDW levels in patients with ACS and evaluate their association with mortality and major adverse cardiac events. Methods: This prospective study included 100 patients with ACS admitted to the Department of General Medicine, MIMS, Mandya. Baseline evaluation included a detailed history, risk factor assessment, clinical examination, and laboratory investigations—RDW, complete hemogram with peripheral smear, creatine phosphokinase-MB, troponin I, fasting lipid profile, liver and renal function tests, random blood sugar, and thyroid function tests—along with electrocardiography and echocardiography. Patients were followed for three months, during which repeat hospitalizations, mortality, and post-ACS cardiac status were recorded. Survivors underwent repeat electrocardiography and echocardiography. Results: Chest pain was the most common presenting symptom. The major risk factors identified were diabetes, hypertension, dyslipidemia, smoking, and alcohol use. Of the 100 patients, 31 had STEMI, 55 had NSTEMI, and 14 had unstable angina. Among 36 patients with arrhythmia, 32 had elevated RDW. All 36 patients who experienced repeat angina had elevated RDW. Of 38 patients with heart failure, 37 had high RDW. All three patients who died during follow-up had elevated RDW. Conclusion: RDW is a simple, cost-effective, and readily available parameter that can serve as a valuable adjunct in diagnosing ACS and predicting prognosis. Elevated RDW levels are strongly associated with adverse outcomes, including arrhythmia, recurrent angina, heart failure, and mortality, and may help guide timely medical or surgical interventions.

Introduction: Acute myocardial infarction (AMI) is defined as ischemia in cardiac muscles due to acute lack of blood supply and therefore oxygen supply.It is a big health issue in both developed and developing countries.Cardiovascular disease (CVD) has become a major health problem in South Asian countries. .Previously it was common in older age group but now it is increasingly recognised in younger age group also leading to it’s devastating sequences for patients and economic burden.The mean age for first presentation of acute coronary events in Indians is 53 years.The exact prevalence of CAD in India is difficult to estimate  . However, studies shows coronery artery disease has increased from 1% in 1960 to 10.5% in 1998 in the urban populaton.young population have combined risk factors like alcohol,smoking, obesity and family history and thrombogenic issues.It is important to identify these modifiable risk factors for prevention.  Aim of this Study: To compare the risk factors like smoking, diabetes mellitus, hyperlipidemia, obesity and hypertension in young patients ( ≤45 years ) with myocardial infarction in >45 years of age.To Assess the angiographic features of coronary artery disease between the two groups. Methodology: We reviewed all cardiac catheterization and in-hospital records of the first 100 patients who underwent this procedure at SSKM between 2021-2022. Of those 100 patients, 50 patients at or under the age of 45 years have been catheterized for evaluation after myocardial infarction . These 50 young patients were compared to 50 randomly selected patients at or above 45 years of age catheterized for evaluation of coronary artery diseases and identified the risk factors Result : The risk factors and short term outcome of acute myocardial infarction in young adults varied from their elderly counterparts. Cigarette smoking has been the single factor most strongly associated with CAD especially in the young adult population. Diabetes and dyslipidemia are also frequently present in young CAD patients. In our study in the less than 40 years group,88% were men, cigarette smoking was more. Hypertension and diabetes were more frequent in the elderly group in our study .The short term outcome in the younger patients in our study was better than the older ones . In our study with family history and smoking  being common in younger patients. Young patients with significant coronary obstruction have less extensive disease than older patients .  Anterior wall MI was more in both groups ( 58% vs 42% ) followed by Inferior wall MI and NST-ACS more common in the age > 45 group ( 4% vs 18%). .Mean systolic blood pressure and diastolic blood pressure were not statisticallysignificant.Lipid profile shows significant p values.In our study patients with young MI had 35.5%, and patients with age more than or equal to 45 years had 10% normal coronary arteries. In our study, homocysteine levels were above normal in 48% of the patients. Conclusion: Young MI patients (age 45 years) patients who have had a myocardial infarction have less extensive coronary artery disease than older (more than or equal to 45 years) patients, with a significant incidence of angiographically normal vessels and with left main.The Risk factor analysis reveals that hypertension and hyperlipidemia were more common in older patients while smoking was common in both the groups being more frequent in younger age groups.To Slow the momentum of Coronary artery disease , particularly among the working-age population, major initiatives are needed to combat CAD, whether promotion of diet and physical activity, generation of awareness , or development of guidelines for risk factors and therapeutic and surgical strategies.

Background: Premature coronary artery disease (CAD), defined as myocardial infarction occurring in individuals aged ≤40 years, is an increasingly recognized clinical entity with distinct risk factors, presentation, and angiographic features compared to older patients. Early identification and intervention in this population are essential to reduce long-term morbidity and mortality. Objectives: To evaluate the clinical, biochemical, and angiographic profile of young patients presenting with acute myocardial infarction and assess the prevalence of conventional and non-conventional risk factors. Materials and Methods: This was a prospective observational study conducted over one year in the Intensive Coronary Care Unit of a tertiary care center. A total of 69 patients aged ≤40 years presenting with acute coronary syndrome (STEMI or NSTEMI) were included. Data on demographics, risk factors, echocardiographic findings, and coronary angiographic patterns were collected. Logistic regression was used to identify predictors of left ventricular (LV) dysfunction. Results: The study population consisted predominantly of males (86.95%), with the majority aged between 31–40 years. Smoking (53.6%), dyslipidemia (29%), and diabetes (24.6%) were major conventional risk factors. A striking 49.3% had prediabetes irrespective of gender, income, or residence. STEMI was the most common presentation (72.5%). Echocardiography showed normal LV function in 78.25%, while 21.7% had LV dysfunction. Coronary angiography revealed single-vessel disease in 62.3%, with LAD involvement in 47.8%. Logistic regression identified diabetes, elevated LDL (>100 mg/dL), hyperhomocysteinemia, and STEMI presentation as independent predictors of LV dysfunction. Conclusion: Premature myocardial infarction in young adults is strongly associated with modifiable risk factors, especially smoking, dyslipidemia, and prediabetes. Early metabolic screening, lifestyle intervention, and timely revascularization are critical for improving outcomes in this population. The findings call for urgent public health measures focused on primary prevention and equitable access to cardiac care for young individuals at risk

Background: Thalidomide, an immunomodulatory agent used in hematologic malignancies, is known to increase thrombotic risk. Arterial thrombosis, including acute myocardial infarction (AMI), is a rare but potentially life-threatening complication. Case presentation: We describe a case of a 49-year-old man with peripheral T-cell lymphoma who developed an ST-elevation myocardial infarction (STEMI) shortly after initiating thalidomide-based chemotherapy. He had a prior history of hypertension and diabetes mellitus. Coronary angiography demonstrated thrombotic occlusion of the distal left anterior descending artery (LAD) and the proximal posterior descending artery (PDA). Thalidomide was discontinued, and the patient was treated as per standard ACS protocols. Conclusions: This case highlights the risk of arterial thrombosis with thalidomide, particularly in patients with preexisting cardiovascular disease. Clinicians should exercise caution when initiating thalidomide in high-risk individuals and maintain vigilance for early cardiac symptoms

Leprosy as medical malady presents with different clinical spectra from tuberculoid to lepromatous profile in typical presentations. However, sometimes leprosy can be considered as a dissimulated disease, mainly when presented as atypical cases leading to mistaken diagnosis and causing dilemma for clinicians. In this case series our objective was to report case series of six patients who came to mycobacteriology laboratory for slit skin smear with partial diagnosis of acute myocardial infarction and arterial and venous thrombosis and with chronic neurological symptoms; the sixth patient was referred with a suspicion of infected skin ulcer. Positive findings in these patients included hypo-aesthetic patches, claw hand, madarosis and ulcers.Unfortunately, in many patients, leprosy was often misdiagnosed as other medical conditions like sarcoidosis, syphilis and other dermato-neurological conditions for long periods, thus delaying initiation of specific treatment. This current case series is intended to increase physicians’ awareness to recognize unusual and atypical leprosy cases which are presented as unusual forms, so that these can be timely diagnosed, promptly treated and sequelae or debilitation can be prevented

Background: Acute myocardial infarction (AMI) remains a significant cause of cardiovascular mortality worldwide. In India, the age-standardized CVD death rate is 272 per 100,000—significantly above the global average. Early risk stratification is vital to guide treatment and improve prognosis. The Global Registry of Acute Coronary Events (GRACE) score is a validated tool to predict in-hospital mortality in acute coronary syndromes (ACS), including ST-elevation myocardial infarction (STEMI). Objective: To evaluate the prognostic accuracy of the GRACE risk score in predicting in-hospital outcomes among patients with STEMI. Methods: A prospective observational study was conducted on 44 patients admitted with STEMI to a tertiary care hospital. Diagnosis was based on clinical presentation, ECG, and cardiac biomarkers. GRACE scores were calculated at admission using eight clinical variables. Patients were stratified into low, intermediate, and high-risk groups and monitored for in-hospital outcomes. Results: The mean GRACE score was 134.9 ± 36.9. Of 44 patients, 6 (13.6%) died during hospitalization—all belonged to the high-risk GRACE category (>140). No mortality occurred in the low or intermediate groups. Higher GRACE scores, advanced Killip class, and lower systolic blood pressure were significantly associated with adverse outcomes. Conclusion: The GRACE score demonstrated strong predictive value for in-hospital mortality in STEMI patients. Its routine use at admission can aid clinicians in identifying high-risk patients, guiding interventions, and informing prognosis discussions.

Introduction: This was a Prospective Cohort study of 50 Patients who were admitted to the N.S.C.B. Medical College Hospital, JABALPUR, with diagnosis of Acute Myocardial Infarction between 1st November 2013 to 31st October 2014.A control group of 100 normal subjects, matched according to age and sex, with the cases were also studied. Patients who fulfil the inclusion and exclusion criteria were enrolled for the study after getting written informed consent. ECG recordings were done on admission, day 2 & day 5. ECG was recorded with an ECG recorder speed of 25mm/sec. In the control group, ECGs were obtained after a 5 minutes resting period with the patients lying comfortably in the supine position.It showed QRS fragmentation is moderately sensitive and highly specific marker for identification of scar in myocardium irrespective of presence of q wave.

Background: Glycated hemoglobin (HbA1c) reflects chronic glycaemic exposure and has emerged as a prognostic biomarker in acute myocardial infarction (AMI). However, data from central India on the relationship between chronic and acute hyperglycaemia and AMI severity and outcomes remain limited. Objectives: To describe the prevalence of chronic and acute dysglycaemia in AMI patients and to evaluate the association of admission HbA1c and random blood sugar (RBS) with infarct severity, left ventricular function, in-hospital complications, and mortality. Material and Methods: In this prospective observational study conducted from July 2023 to December 2024 at Netaji Subhash Chandra Bose Medical College, Jabalpur, 160 consecutive patients aged 18–60 years with confirmed AMI were enrolled. Admission RBS and HbA1c were measured, and all patients underwent 12-lead ECG and two-dimensional echocardiography to assess infarct type, myocardial territory, and left ventricular ejection fraction (LVEF). In-hospital complications and mortality were recorded. Statistical analysis was performed using SPSS v26.0; categorical variables were compared by Chi-square or Fisher’s exact tests, and continuous variables by t-test or ANOVA. A p-value <0.05 denoted significance. Results: The cohort was predominantly male (75.6%) and presented largely with STEMI (84.4%). Admission hyperglycaemia (RBS ≥200 mg/dL) was noted in 36.3% of patients, while 70.0% had HbA1c ≥6.1%, including 22.5% with HbA1c >8.0%. Overall, in-hospital mortality was 4.4%; all deaths occurred in the HbA1c >8.0% subgroup (19.4% vs. 0% for HbA1c ≤8.0%; p<0.0001) and were significantly associated with admission hyperglycaemia (10.3% vs. 1.0% for RBS <200 mg/dL; p=0.009). LVEF <40% was observed in 40.6% and was more frequent in anterior/inferior MI (p=0.044). No significant links were found between HbA1c and infarct type or myocardial territory, nor between age, sex, or substance-use habits and mortality. Conclusion: Chronic and acute dysglycaemia are highly prevalent in AMI and independently predict in-hospital mortality. Routine assessment of HbA1c and admission glucose in all AMI patients is warranted to enhance risk stratification and guide acute management

Background: Acute coronary syndrome (ACS) includes unstable angina, NSTEMI, and STEMI, all resulting from reduced myocardial blood flow, commonly due to plaque rupture and thrombosis. Early diagnosis relies heavily on electrocardiography (ECG) and cardiac biomarkers, particularly troponin I. This study assessed the correlation between various ECG changes and troponin I levels in patients presenting with chest pain to the emergency department. Methods: A cross-sectional study was conducted among 200 adult patients (>18 years) presenting with chest pain and specific ECG abnormalities over a 12-month period. ECG findings were categorized into ST-segment elevation, ST-segment depression, T-wave inversion, hyperacute T waves, and bundle branch block. Troponin I was measured using a rapid qualitative immunoassay. Demographic characteristics were analyzed to identify age and sex trends. Results: Of the 200 patients, 134 were male and 66 were female. The majority belonged to the 45–65-year age group (n=106). Troponin I positivity was seen in 76 males (56.7%) and 37 females (56%). Age-wise, troponin positivity was highest in the 45–65-year group (n=66), followed by >65 years (n=33) and <45 years (n=12). ST-segment elevation showed the strongest correlation with troponin I positivity (98%). Troponin positivity was also seen in patients with ST-segment depression (46%), hyperacute T waves (50%), T-wave inversion (33%), and bundle branch block (25%). Conclusion: ST-segment elevation on ECG is highly predictive of troponin I positivity and acute myocardial infarction. Middle-aged males demonstrated the highest burden of ACS. The combined use of ECG interpretation and troponin I testing remains essential for early identification and management of ACS in emergency care.

Background and Objectives: : Acute Myocardial Infarction (AMI) is characterized by a profound disturbance in autonomic nervous system homeostasis and an intense inflammatory response. Serum cholinesterase (CHE), specifically butyrylcholinesterase, is an enzyme synthesized by the liver that has recently emerged as a biomarker for parasympathetic tone and hepatic reserve. While its role in organophosphate poisoning and liver failure is well-established, its prognostic value in the context of myocardial ischemia remains under investigation. Methods: We conducted a prospective, observational comparative study involving 240 participants: 120 patients with confirmed AMI (STEMI and NSTEMI) and 120 age- and sex-matched healthy controls. Serum CHE was measured upon admission. The AMI cohort was further stratified based on the occurrence of MACE (cardiogenic shock, re-infarction, severe arrhythmias, or death) during the hospital stay. Results: The mean serum CHE level was significantly lower in the AMI group compared to the control group (4,820±1,150 U/L vs. 8,450±1,620 U/L, p<0.001). Within the AMI cohort, patients who developed MACE (n=38) had significantly lower admission CHE levels compared to those with an uncomplicated course (3,150±890 U/L vs. 5,590±1,040 U/L, p<0.001). Receiver Operating Characteristic (ROC) analysis indicated that a CHE cutoff of <4,200 U/L predicted in-hospital mortality with a sensitivity of 88.2% and specificity of 79.5%. A negative correlation was observed between CHE and C-reactive protein (r=-0.62,p<0.001). Conclusion: Serum CHE is significantly reduced in the acute phase of myocardial infarction. Lower levels are strongly associated with severe adverse cardiac events and early mortality. CHE represents a promising, cost-effective biomarker for risk stratification in AMI

Background: Acute myocardial infarction (AMI), a major manifestation of coronary artery disease (CAD), remains a significant global health burden. Depression is increasingly recognized as an independent risk factor for adverse cardiac outcomes and a common complication following AMI, yet it is often underdiagnosed in low- and middle-income countries like India. This study aimed to determine the prevalence and determinants of depression among survivors of a first episode of AMI. Methods: A cross-sectional study was conducted in the Department of Cardiology at a multispecialty teaching hospital. A total of 551 adult survivors of a first episode of AMI were enrolled. Sociodemographic and clinical data were collected using structured questionnaires, and depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). The prevalence of depression was calculated, and its association with sociodemographic and clinical variables was assessed. Results: Among 551 patients, the majority aged between 51–70 years (62.5%). The prevalence of depression (PHQ-9 >9) among AMI survivors at one month was 27.2%. While out of total sample, 23.0% had no depression (PHQ-9 = 0), 76.9% reported at least one depressive symptom (PHQ-9 ≥1). Severity distribution showed 39.6% had minimal depression, 10.2% mild depression, 20.1% moderate depression, 4.9% moderately severe depression, and 2.2% severe depression. Female gender was significantly associated with higher depression rates (χ² = 38.288, p = 0.001; odds ratio [OR] = 6.55, 95% confidence interval [CI]: 3.71–11.58).  Conclusion: This study demonstrates that more than one-fourth of AMI survivors experience clinical depression within one month of the event, and the majority report at least some depressive symptoms. Routine depression screening and incorporation of psychosocial interventions into cardiac rehabilitation are imperative to improve quality of life and long-term outcomes in AMI survivors.