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Related Concept Videos

Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

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IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
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Acute Coronary Syndrome III: Diagnostic Studies01:30

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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 I: Introduction01:30

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Coronary Artery Disease (CAD): An Overview with Scientific InsightsCoronary Artery Disease (CAD), often referred to as C-A-D, is a prevalent blood vessel disorder classified under the broader category of atherosclerosis. Atherosclerosis is a pathological process characterized by the hardening and narrowing of arteries due to the accumulation of atherosclerotic plaques. These plaques are composed of cholesterol, fatty substances, inflammatory cells, calcium, and fibrin, reducing blood flow to...
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Acute Coronary Syndrome I: Introduction01:30

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Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
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Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations01:19

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The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
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Aortic Regurgitation III: Medical Management01:25

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Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
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Mortality in Patients Hospitalized With Acute Myocardial Infarction Without Standard Modifiable Risk Factors: The

Zainali S Chunawala1, Melissa C Caughey2, Deepak L Bhatt3

  • 1Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX USA.

Journal of the American Heart Association
|June 29, 2023
PubMed
Summary
This summary is machine-generated.

Patients experiencing acute myocardial infarction (AMI) without standard modifiable cardiovascular risk factors (SMuRFs) face higher mortality rates. This highlights a critical need for improved risk identification and treatment strategies for SMuRFless individuals.

Keywords:
acute coronary syndromeacute myocardial infarctioncardiovascular diseasechest painstandard modifiable risk factors

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Area of Science:

  • Cardiology
  • Public Health
  • Epidemiology

Background:

  • Standard modifiable cardiovascular risk factors (SMuRFs) include diabetes, hypertension, smoking, and hypercholesterolemia.
  • Prevention strategies targeting SMuRFs are crucial for cardiovascular disease (CVD) outcomes.
  • Acute myocardial infarction (AMI) occurs even in individuals without these risk factors, but their characteristics and prognosis are poorly understood.

Purpose of the Study:

  • To characterize the clinical profile and prognosis of patients with AMI who lack documented SMuRFs.
  • To compare treatment patterns and mortality rates between AMI patients with and without SMuRFs.

Main Methods:

  • Analysis of AMI hospitalizations from 2000-2014 using the ARIC study surveillance data.
  • AMI classification by physician review using a validated algorithm.
  • Abstraction of clinical data, medications, and procedures from medical records; outcomes included 28-day and 1-year mortality.

Main Results:

  • 3.6% of 20,569 AMI patients had no documented SMuRFs.
  • SMuRFless patients received less aspirin, antiplatelet therapy, beta-blockers, and fewer revascularization procedures.
  • SMuRFless AMI patients had significantly higher adjusted 28-day (OR 3.23) and 1-year (HR 2.09) mortality.
  • 28-day mortality for SMuRFless patients increased from 7% to 27% between 2000-2014, while it declined for those with SMuRFs.

Conclusions:

  • AMI patients without SMuRFs exhibit increased all-cause mortality and receive guideline-directed medical therapy less frequently.
  • This underscores the need for evidence-based pharmacotherapy and novel risk markers for early identification in the SMuRFless population.