Clinical Features of Acute Myocardial Infarction in Elderly Patients

The aim of this study was to clarify the prevalence of coronary risk factors in order to characterize the prognostic factors in elderly patients and to also identify any factors beneficial for the prevention of further cardiac events and death. We studied 888 patients with ST-elevation acute myocardial infarction who were admitted within 48h of symptom onset. The patients were divided into 3 groups according to age for comparison of variables:a younger group (n＝99) aged＜50, a middle-aged group (n＝435)＞51 years but＜70 years and an elderly group (n＝354) aged＞71 years. The elderly group had higher rates of female gender, pulmonary congestion, in-hospital mortality, and atrial fibrillation and a higher plasma concentration of high-sensitivity CRP (hs-CRP) (p＜0.05). Hypertension, diabetes mellitus, and dyslipidemia were more common in the middle-aged group (p＜0.05). The prevalence of smokers and the plasma level of total cholesterol, LDL-cholesterol and triglycerides were lower in the elderly group (p＜0.05). The grade of collateral circulation was highest in the elderly group, but the success rate of reperfusion therapy was lowest. Multiple regression analysis showed that age, pulmonary congestion, CKD and hs-CRP were predictors of in-hospital mortality.This investigation indicated that elderly patients with acute myocardial infarction have different clinical characteristics than younger patients. A specific algorithm might be needed in elderly patients, and could use hs-CRP, eGFR and atrial fibrillation as factors

Sex Difference of In-hospital Mortality in Patients with Acute Myocardial Infarction

Factors contributing to the sex difference of in-hospital mortality after acute myocardial infarction (MI) are still unknown. We compared the clinical characteristics on admission and in-hospital outcome of consecutive 1,354 patients with acute MI between the 2 sexes. Age on admission was about 7 years older in women than in men. In-hospital death was significantly more frequent in women. Pulmonary congestion and hypertension were more likely in women with higher serum levels of total cholesterol and LDL cholesterol. A higher prevalence of current smoking and inferior wall involvement and lower serum HDL cholesterol level were observed in man. After adjusting for age, adverse in-hospital mortality for women was observed in both younger and older patients. Multivariate logistic regression analysis demonstrated that age, location of infarction, recanalization and serum C-reactive protein (CRP) concentration were independent predictors for in-hospital mortality for overall patients, while age and recanalization were independent predictors for male gender, and pulmonary congestion and serum CRP concentration were independent predictors for female gender. In-hospital outcome after acute MI was worse in women. A multivariate logistic regression model revealed that the sexually different factors affected in-hospital mortality in females

Postprandial Hypotension due to a Lack of Sympathetic Compensation in Patients with Diabetes Mellitus.

Postprandial hypotension is an important hemodynamic abnormality in diabetes mellitus, but few reports are available on the relationship between autonomic dysfunction and postprandial hypotension. Ten diabetic patients and 10 healthy volunteers were recruited for this study. Postural blood pressure and heart rate changes were measured before lunch, and then the hemodynamic responses to a standardized meal were investigated. Holter electrocardiogram (ECG) monitoring was conducted for assessing spectral powers and time-domain parameters of RR variations. Postural changes from the supine to the upright position decreased the systolic blood pressure of the diabetics from 133(+-)16 to 107(+-)20 mmHg (p<0.01), but did not decrease the systolic blood pressure of the controls. The heart rate remained constant in the diabetics but was increased in the controls. Food ingestion decreased systolic blood pressure in the diabetics, with a maximum reduction of 25(+-)5 mmHg. This decrease was not associated with any changes in the ratio of low frequency to high frequency, and yet the heart rate remained almost constant. Indexes involving parasympathetic tone were not affected. Food ingestion did not affect blood pressure in the control group. These findings suggest that lack of compensatory sympathetic activation is a factor contributing to postprandial hypotension in diabetics, and that parasympathetic drive does not make a significant contribution to this condition

Prognostic significance of right bundle branch block in patients with acute inferior myocardial infarction

There is little information available concerning the influence of right bundle branch block (RBBB) on the prognosis of patients with inferior myocardial infarction (MI). In this study we evaluated the influence of RBBB on the short-term prognosis of patients with inferior MI. Our study subjects were 1,265 hospitalized patients with Q wave MI. Patients were divided into 4 groups based on the presence or absence of RBBB and on the location of the infarction. RBBB was classified into 4 categories according to the timing of its appearance and its duration as new permanent, transient, old and age indeterminate. In-hospital death and pulmonary congestion were observed more frequently in patients with RBBB than in those without RBBB. Moreover, in inferior MI as in anterior MI, in-hospital death and pulmonary congestion occurred more frequently in new permanent RBBB patients than in patients with other types of RBBB. Multivariate regression analysis reveals that new permanent RBBB was a strong independent predictor for an adverse short-term prognosis in patients with inferior MI, as well as in patients with anterior MI. New permanent RBBB during inferior MI is a strong independent predictor for increased in-hospital mortality, regardless of the infarction location.</p

Correlation of vectorcardiographic findings with patterns of left ventricular hypertrophy in hypertrophic cardiomyopathy

We compared vectorcardiographic (VCG) findings with the distribution of hypertrophy in patients with hypertrophic cardiomyopathy (HCM). Distribution of left ventricular hypertrophy was determined by both echocardiogram (UCG) and magnetic resonance imaging (MRI). According to the specific hypertrophic site evaluated by UCG and MRI, 43 patients with HCM were classified into 4 types : septal, anterior, posterolateral or apical type. In patients classified as anterior, posterolateral and apical types, the QRS loop was directed toward the hypertrophic site because of increased electromotive force in the hypertrophic site. In contrast, in patients classified as septal types, the QRS loop was directed away from the hypertrophic site. This opposite direction was probably due to altered electromotive force and/or conduction disturbance in the hypertrophic site as the disease progressed. The present study indicates that QRS loop direction suggests the location of hypertrophy. The T loop was most slender in patients with apical hypertrophy and the slenderness was associated with the relative degree of hypertrophy in the apex compared with hypertrophy in other sites

Correlation of vectorcardiographic findings with patterns of left ventricular hypertrophy in hypertrophic cardiomyopathy

We compared vectorcardiographic (VCG) findings with the distribution of hypertrophy in patients with hypertrophic cardiomyopathy (HCM). Distribution of left ventricular hypertrophy was determined by both echocardiogram (UCG) and magnetic resonance imaging (MRI). According to the specific hypertrophic site evaluated by UCG and MRI, 43 patients with HCM were classified into 4 types : septal, anterior, posterolateral or apical type. In patients classified as anterior, posterolateral and apical types, the QRS loop was directed toward the hypertrophic site because of increased electromotive force in the hypertrophic site. In contrast, in patients classified as septal types, the QRS loop was directed away from the hypertrophic site. This opposite direction was probably due to altered electromotive force and/or conduction disturbance in the hypertrophic site as the disease progressed. The present study indicates that QRS loop direction suggests the location of hypertrophy. The T loop was most slender in patients with apical hypertrophy and the slenderness was associated with the relative degree of hypertrophy in the apex compared with hypertrophy in other sites