Analysis of ST-elevation myocardial infarction occurring in soldiers during strenous military training
Navreet Singh1, Anil Kumar2, Rajat Datta3
1Senior Advisor (Medicine) & Cardiologist, AFCME, Subroto Park, New Delhi, India.
Insights
Strenuous military training can trigger ST-Elevation Myocardial Infarction (STEMI). Early thrombolysis and aspiration show excellent results, highlighting the need for graded training to prevent such cardiac events.
Area of Science:
- Cardiology
- Sports Medicine
- Military Health
Background:
- Acute ST-Elevation Myocardial Infarction (STEMI) is increasingly observed in soldiers following strenuous activities like the Battle Field Efficiency Test (BPET).
- Understanding the specific triggers and patient profiles is crucial for effective management and prevention.
Purpose of the Study:
- To analyze precipitating causes, risk factors, and symptoms in soldiers experiencing STEMI during strenuous military training.
- To evaluate the efficacy of current management protocols for STEMI in this population.
Main Methods:
- A single-center observational study was conducted.
- Data on 25 soldiers with STEMI post-strenuous military training were assimilated and analyzed.
- Precipitating factors, clinical presentation, and treatment outcomes were assessed.
Main Results:
- Chest pain was the primary symptom in all 25 soldiers with STEMI.
- 88% experienced symptoms during or within one hour of strenuous activity.
- Thrombolysis was successful in 76% of cases (95% angiographic success); primary PCI was feasible in 12%.
Conclusions:
- STEMI induced by unaccustomed strenuous military training typically involves single-vessel disease with a favorable response to thrombolysis and thrombus aspiration.
- Prompt revascularization therapy significantly preserves ventricular function.
- Inadequate training for strenuous activities is a strong risk factor, emphasizing the need for comprehensive, graded physical preparation to prevent acute coronary syndromes.
Background:
At our tertiary care cardiology center, we are receiving soldiers who sustained acute ST-Elevation Myocardial Infarction (STEMI) during the strenuous Battle Field Efficiency Test (BPET) and other such activities.
Methods:
This was a single-center observational study to assimilate and analyze the precipitating causes, risk factors, symptoms, and the efficacy of the management protocols in soldiers sustaining STEMI during the BPET or other forms of strenuous military training.
Results:
All 25 soldiers with documented STEMI following strenuous military training presented with chest pain as the primary symptom. 88% had symptoms either during or within 1st hour of the strenuous activity. 76% underwent thrombolysis with an angiographic success rate of 95%. Primary PCI was possible in only 3/25 (12%) of the cases, of which 2 (66%) did not require stenting after thrombus aspiration; 88% of soldiers reported "training for the event" for less than four times/week.
Conclusion:
STEMI precipitated by strenuous unaccustomed military training have exclusively single vessel affection with an excellent response to thrombolysis and thrombus aspiration. Thus, the timely institution of pharmacological or mechanical revascularization therapy has dramatic results in the preservation of ventricular function. The lack of training for the strenuous event provides strong evidence for comprehensive, graded, physical training prior to strenuous military activities to prevent acute coronary syndromes.
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