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Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
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Coronary Artery Disease (CAD) is a primary health risk worldwide, leading to significant morbidity and mortality. The condition arises from the buildup of atherosclerotic plaques within the coronary arteries, resulting in diminished blood supply to the heart muscle.The clinical manifestations of CAD vary widely, from asymptomatic stages to severe, life-threatening conditions. Understanding these manifestations is crucial for early diagnosis and effective management.Angina Pectoris: The Warning...
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Myocarditis is inflammation of the myocardium, which is the muscular layer of the heart.EtiologyMyocarditis has a diverse etiology, including a wide range of infectious and non-infectious causes:Infectious CausesViral: Common viruses include Coxsackie A and B, adenovirus, parvovirus B19, enteroviruses, and influenza A.Bacterial: Examples include infections caused by Streptococcus, Staphylococcus, and Mycoplasma species.Rickettsial: Infections like Rocky Mountain spotted fever can result in...
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Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...
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Are non-ST-segment elevation myocardial infarctions missing in China?

Karthik Murugiah1, Yongfei Wang1,2, Sudhakar V Nuti3

  • 1Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 330 Cedar St, Boardman 110, P.O. Box 208056, New Haven, Connecticut 06520-8056, USA.

European Heart Journal. Quality of Care & Clinical Outcomes
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PubMed
Summary

ST-segment elevation myocardial infarction (STEMI) is dominant in China, with non-ST-segment elevation myocardial infarction (NSTEMI) increasing. Lower biomarker use and hospital factors did not explain the STEMI predominance in acute myocardial infarction (AMI) cases.

Keywords:
Acute myocardial infarctionLow- and middle-income countriesST-segment elevation myocardial infarction

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Area of Science:

  • Cardiology
  • Epidemiology
  • Health Services Research

Background:

  • ST-segment elevation myocardial infarction (STEMI) is more prevalent than non-ST-segment elevation myocardial infarction (NSTEMI) in China and other low- to middle-income countries.
  • A hypothesis suggests this STEMI predominance is linked to reduced biomarker utilization and may be influenced by hospital attributes.

Purpose of the Study:

  • To investigate the association between STEMI predominance and biomarker use in acute myocardial infarction (AMI) patients in China.
  • To examine how hospital characteristics influence the proportion of NSTEMI cases across different healthcare settings.

Main Methods:

  • Analysis of a nationally representative dataset (China PEACE-Retrospective AMI Study) from 2001, 2006, and 2011.
  • Comparison of hospital NSTEMI proportions based on the use of cardiac biomarkers (CK, CK-MB, troponin) and troponin specifically.
  • Evaluation across various hospital factors including region, location, level, and teaching status.

Main Results:

  • Out of 15,416 AMI patients, 14% were diagnosed with NSTEMI; these patients were generally older, more often female, and had more comorbidities.
  • Median hospital NSTEMI proportions remained consistent across different levels of biomarker use and hospital characteristics.
  • While NSTEMI admissions increased significantly from 2001 to 2011, biomarker use and hospital factors did not correlate with the low NSTEMI rate.

Conclusions:

  • STEMI remains the primary presentation of AMI in China, although the incidence of NSTEMI is rising.
  • Biomarker utilization and hospital characteristics do not appear to account for the observed low rate of NSTEMI in the Chinese context.