Clinical profile of acute myocardial infarction in the young

 

 

Abstract              Background: There is a rising incidence of acute myocardial infarction (MI) in young adults. It is important to identify and control cardiovascular risk factors at an early age to prevent the incidence in cases of young MI. Aim: To study the clinical profile of acute myocardial infarction in young patients. Material and Methods: Patients aged 40 years or younger admitted to with a diagnosis of acute MI were studied for clinical presentations, risk factors and management outcome. Results: Majority of patients presented with typical chest pain. 5 patients presented with atypical symptoms, one had only sweating, two had heaviness of chest, one had epigastric pain, one had sudden collapse. The most common risk factor was smoking in 68% followed by alcoholism 40%, Obesity 38%, Metabolic syndrome 38%, HTN 28% DM 26%. Of the total 50 patients, 47 (94%) patients survived whereas 3 (6%) patients succumb to death. Conclusion: There is a need to increase awareness among the young population regarding the entity of MI in young hence stressing on modifying life style. This simple measure can make a large difference in preventing the occurrence of MI in young.

Key Words: Young adults, myocardial infarction, presentation, risk factors, outcome

 

INTRODUCTION

Cardiovascular diseases are one of the major health problems reaching epidemic proportions. In fact, they are the most common cause of deaths in the world followed by cancer. Previous studies have reported that there is a rising incidence of acute myocardial infarction in the young. Although acute MI is an uncommon entity in the young, it constitutes the incidence is increasing in young patients and has become important problem for such patients and their treating physicians because of its devastating effect on their more active lifestyle. There is a rising incidence of acute MI in young adults.¹ Although acute MI mainly occurs in older patients, young men and women can suffer MI. This disease carries a significant morbidity, psychological effects and financial constraints for the person and the family when it occurs at a younger age.² Hence, it is important to identify and control cardiovascular risk factors at an early age to prevent the incidence in cases of young MI, to reduce the risk of MI at young age, to reduce the severity and complications. So, this study was carried out to study the clinical profile of acute myocardial infarction in young patients.

 

MATERIAL AND METHODS

This descriptive observational study was carried out in the Department of Medicine of a Tertiary Care Centre in Maharashtra over a period of two years. Approval from Institutional Ethical Committee was taken prior to the commencement of the study.

Study population

Patients aged 40 years or younger admitted to with a diagnosis of acute MI during the period of the study.

Inclusion Criteria

All patients aged 40 years or younger admitted with a diagnosis of acute MI. Most published studies have used a cut off point of 40 years and below to define young MI, hence in this study patients in the age 40 years and below were included. The final diagnosis of acute MI was based on two of the following criteria - ischemic chest pain for at least 30 minutes and ECG evidence of myocardial injury.¹

Exclusion Criteria

• Patients aged < 18 years
• Those patients 40 years or younger with acute MI who refused to give their written informed consent for the study.
• Patient who were not wished to continue in the study after giving the consent.

The patients were interviewed (or their relatives) who were eligible and given such written informed consent. The complete history was taken and the clinical examination was done. The weight and height measurements were converted into body mass index BMI= weight (kg) / Height (meters)2. ECG and echocardiography was done along with angiography. Patients were managed accordingly.

Statistical analysis

Statistical analysis was carried out with the help of SPSS (version 20) for Windows package (SPSS Science, Chicago, IL, USA).

 

RESULTS

Patients belonged to age groups varying from 20 years to 40 years with a mean age of 34.16±4.81. Majority of patients belonged to age group of 36-40 years. Majoritie were males (88%), and only 6 patients (12%) were females. There were 14 patients who had a normal BMI (28%). 28 patients had BMI between 25-30 kg/m2(56%). 8 patients had BMI between 31-35 kg/m2(16%). Out of 50 patients, 18% of patients belonged to lower class, the number of patients in middle class were 52%, and 30% patients were from lower middle class.

 

Table 1: Characteristics of the study population

Majority of patients presented with typical chest pain. 5 patients presented with atypical symptoms, one had only sweating, two had heaviness of chest, one had epigastric pain, one had sudden collapse.

Table 2: Clinical presentation of study population

 Out of 50 patients with MI, 2% had family history of IHD, 24% had DM, and 36% had family history of HTN. Out of 50 patients, most common risk factor is smoking which is 68 %. Descending order of risk associated with MI in young was alcoholism 40%, Obesity 38%, Metabolic syndrome 38%, HTN 28% DM 26%, IHD 4%, and CKD 4%. Out of 50 patients, 45 (90%) patients have increased serial CPK MB and 5 (10%) patients have normal serial CPK MB. On ECG, 24 patients had AWMI (48%), 3 had anterolateral, 1 had anterior and inferior wall MI and 2 had anteroseptal MI. A total 38% i.e. 21 patients had inferior wall MI (IWMI- 42%). Out of 50 patients, 47 (94%) patients have increased Trop I and 3(6%) patients have normal Trop I. In patients with severe LV systolic dysfunction, all had AWMI. In the moderate LV systolic dysfunction group, 8 had AWMI and 4 had IWMI, and each 1 patient anteroseptal and anterolateral wall MI. In the mild dysfunction group, 7 had AWMI, 11 had IWMI and 2 had anterolateral location and 1 0f Anterior+Inferior wall MI.47 patients underwent coronary angiogram. 3 patients did not give consent for coronary angiogram. 38 patients had SVD (76%), 6 patients had DVD (12%). 3 patients had triple vessel disease (6%).

 

Table 3: Type of treatment given

Majority of patients (38) underwent PTCA and stenting (76%), 8 underwent thrombolysis (16%), 2 patients had to undergo rescue PTCA as one patient developed hypersensitivity reaction and one had failure of thrombolysis. 2 patients with TVD underwent CABG. One patient did not undergo either thrombolysis as he presented too late for thrombolysis, or PTCA could not be done as he had developed acute renal failure. He was treated with antiplatelet agents. Of the total 50 patients, 47(94%) patients survived whereas 3(6%) patients succumb to death.

 

DISCUSSION

This was an observational study of clinical profile of 50 patients aged 40 and below admitted with a diagnosis of acute MI. In this study MI in young was found to be more common in males as compared to females. MI in young was distinctly rare in premenopausal women. Also in a study on MI in young, Choudhury L and Marsh JD³ have concluded that MI in young is predominantly a disease of men. In our study majority of patients were in the age group of 30 – 40 years. In a study done by Tambyah et al⁴ on premature MI of the 32 patients studied, ages ranged from 32 to 40 years. About 25% of acute MI in India occur under the age group of 40 and 50% under the age group of 50. One center reported a 47-fold increase in the incidence of first MI under the age of 40 in the last 20 years.⁵Majority of patients presented with typical chest pain in this study. In a study done by Chen et al⁶ was concluded that younger patients with coronary artery disease commonly present with an acute coronary syndrome without history of angina. In this study AWMI was most frequent location of MI on ECG. In a study done by Tambyah et al⁴ on MI in young AWMI was the most common location of MI. In a study done by Stone et al⁵ patients with anterior infarction had a substantially worse in-hospital and follow-up clinical course compared with those with inferior infarction, evidenced by a larger infarct size, lower admission left ventricular ejection fraction and higher incidence of heart failure and serious ventricular ectopic activity, in-hospital death and total cumulative cardiac mortality. In this study also AWMI was found in 5 out of 6 patients who had complications like complicated arrhythmias, cardiogenic shock and cardiac arrest. In our study all patients had atherosclerotic changes on CAG, single vessel disease is the most common feature, LAD was most common infarct related artery. In a study done by Tmbyah et al⁴ on MI in young all patients had evidence of atherosclerotic disease, majority had single vessel disease and LAD was the most common infarct related artery. In another study done by Chen et al,⁶ premature coronary artery disease was associated with acute coronary syndromes and complex stenosis morphologic features at angiography. Irregular lesions, filling defects, or both suggesting clot formation or plaque rupture has been recognized by angiography, angioscopy and autopsy in patients with unstable angina and myocardial infarction. In young MI there is angiographically complex stenosis morphologic features, and less extensive coronary artery disease.⁷In this study, smoking, dyslipidemia and metabolic syndrome was the most common risk factor. According to a study done by Ismail et al a majority of young adults with acute MI have at least one identifiable risk factor. The risk factors noted are smoking, diet rich in cholesterol, sedentary lifestyle, diabetes, hypertension, paternal history of cardiovascular disease.² In this study, prothrombotic states were not a risk factor. In this study, complications in young MI is minimal with good outcome in majority. In a study done by Moccetti et al⁸ Survival after myocardial infarction (MI) is influenced by multiple factors, of which age stands out as a major non-modifiable predictor of long term prognosis. Short and medium term prognosis in young MI survivors is known to be excellent. Young MI survivors had less severe coronary disease than older patients, which may explain their early favorable outcome. Left ventricular dysfunction would be expected to influence prognosis. It is important not only to diagnose early and treat adequately acute MI in young also it is essential to identify and prevent or treat risk factors at primary and secondary level. Majority of patients in this study were diagnosed with Diabetes, Hypertension. Patients with family history should especially be screened for risk factors. After the management 94% patients recovered, rest were died. Site for MI was significantly related to the outcome. Of the 3 died patients 2 were having 2 ASMI and 1 of Anterior and Anterior +inferior.

 

CONCLUSION

There is a need to increase awareness among the young population regarding the entity of MI in young hence stressing on modifying life style in terms of healthy diet, exercise, avoiding smoking and screening for risk factors in those at high risk. This simple measure can make a large difference in preventing the occurrence of MI in young.

 

REFERENCES

1. Al-Khadra AH. Clinical profile of young patients with acute MI in Saudi Arabia. International Journal of Cardiology 2003;91:9-13.
2. Egred M, Vishwanath G, Davis GK. Myocardial infarction in young adults. Postgraduate Medical Journal 2005 Dec;81(962):741-5.
3. Choudhury L, Marsh JD. MI in young adults. Am J Medicine 1999;107(3):254-61.
4. Tmbyah PA, Lim YT, Choo MH. Premature MI in Singapore- Risk factor analysis and clinical features. Singapore Medical Journal 1996;37:31-33.
5. Stone PH, et al. Prognostic significance of location of MI American J of Cardiology 1996;78(1):19-25.
6. Chen L, Chester M, Kaski JC. Clinical Factors and Angiographic Features Associated With Premature Coronary Artery Disease. Chest 1995;108;364-369.
7. Gupta et al. Trends in Acute Myocardial Infarction in Young Patients and Differences by Sex and Race, 2001 to 2010. J Am Coll Cardiol 2014;64:337–45.
8. Morccetti et al. Survival after acute MI in young. Archives of Internal Medicine 1997; 157(8):865-9.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Policy for Articles with Open Access
Authors who publish with MedPulse International Journal of Anesthesiology (Print ISSN:2579-0900) (Online ISSN: 2636-4654) agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.