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Article
Predictors of In-Hospital Mortality After Acute Myocardial Infarction

Authors: Zaid Mohammed Ali Hamandi --- Khalid Abdulla Al-Khazraji
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 1 Pages: 46-53
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT: BACKGROUND: Acute myocardial infarction remains a major cause of adult mortality. A steady decline in the mortality rate appears to be due to a fall in the incidence of acute myocardial infarction, a fall in the case fatality rate, identifying those patients who are at increased risk, and more aggressive prophylactic cardiovascular treatments to prevent it from occurring.OBJECTIVE:To identify, patients who have higher risk of in-hospital mortality after the first acute myocardial infarction. PATIENTS AND METHODS: The hospital mortality for the first acute myocardial infarction (AMI) was evaluated for 112 patients who were admitted to the coronary care unit in Baghdad Teaching Hospital during a total period of six months duration, between March and Sept. 2001. For each patient, history, clinical examination, electrocardiograms, fasting venous plasma glucose were done. RESULTS: Total mortality was 16.1%. The following factors were associated with higher in-hospital mortality: advanced age (more than 65 years), females, diabetic, and clinically evident heart failure. Other variables were not associated with increase or decrease in mortality: hypertension, smoking, admission heart rate, bundle branch block, previous angina pectoris, and the site of the infarction. CONCLUSION: Certain groups of patients tend to have higher mortality; patients older than 60 years, females, diabetic and patients with clinical heart failure. Other factors didn’t affect survival; location of the AMI, the presence of bundle branch block, hypertension, angina pectoris, smoking and the high heart rate on admission.


Article
ACUTE MYOCARDIAL INFARCTION AND DEPRESSION
احتشاء عضلة القلب الحاد والاكتئاب

Authors: ALIAS A. HUSSIN --- SABRI K. SHAIKHOW
Journal: Duhok Medical Journal مجلة دهوك الطبية ISSN: eISSN: 20717334/ pISSN: 20717326 Year: 2008 Volume: 2 Issue: 1 Pages: 5-16
Publisher: University of Dohuk جامعة دهوك

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Background Depression found to be common after acute myocardial infarction AMI, its recognition and treatment may be important to reduce its consequences. Objectives To clarify the effect of depression following AMI. Patients and Methods Prospective study was conducted at the coronary care unit (CCU) at Ibn-Sena ,Mosul teaching hospital . Two hundred cases with AMI ages 25 years up to 75 years were included. Results Depression was prevalent after AMI, with a higher incidence in females, 57% vs 43% for males. P value < 0.05 and odds ratio: 2.85, this study found that higher percentage of depression was among those with low educational and socioeconomic state and discovered that patients with depression following AMI developed more cardiac complications such as recurrent angina, recurrent AMI, arrhythmia, congestive cardiac failure (CCF) and death more than non depressed patients, 38% of the depressed group needed coronary angiogram vs 23% of non depressed. Conclusion Patients who developed depression following (AMI) are more prone to complications.


Article
Association between activity at onset of symptoms and complications of St-segment elevation myocardial infarction in Erbil teaching hospital
العلاقة بين النشاط عند ظهور الأعراض ومضاعفات ارتفاع St-segment احتشاء عضلة القلب منفي احتشاء مستشفى أربيل التعليمي

Authors: Baha’ddin Abdulkareem --- Abdulkareem Othman
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2012 Volume: 16 Issue: 1 Pages: 16-22
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objectives: It is controversial whether the onset of myocardial infarction occurs randomly or is precipitated by identifiable stimuli. The aim of this study is to emphasise the relationship of exercise, rest and bed related onset ST-segment elevation myocardial infarction with subsequent in-hospital complications.Methods: The study has been done perspectively having collecting data from those patients whom had been admitted from 1st of November 2008 till 1st of June 2009 to the Coronary Care Unit (CCU) in Hawler Teaching Hospital in Erbil city. The study had included one hundred twenty one patients (84 men, 37 women) whom they exhibited a newly developed ST-segment elevation myocardial infarction (STEMI) over the chronological age ranged from (35-86), mean age (56.76±11.12). Transthoracic echocardiography had been employed over 88 recently admitted patients whose in-hospital complications were precisely being clarified and recorded. The onset of pain of acute myocardial infarction whether during exercise, rest or during sleep (bed) has been verified and studied.Results: Patients whose symptoms of STEMI began at rest, or bed had higher incidence of early acute mitral regurgitation (26, 59.1%), (13,65%) respectively versus exercise related STEMI onset(8,33.3%)p value=0.04.Conclusion: Early echocardiographic examination is recommended especially to patients having had physical body rest in order to detect early bed-related onset STEMI and to diagnose complications like acute mitral regurgitation.


Article
Evidence of Infection with Helicobacter Pylori in Patients With Acute Myocardial Infarction
الدليل على الإصابة بالهليكوباكتر بايلوري عند مرضى إحتشاء العضلة القلبية الحاد

Author: Dr. Ala Hussain Abbase Haider د علاء حسين عباس حيدر
Journal: KUFA MEDICAL JOURNAL مجلة الكوفة الطبية ISSN: 1993517X Year: 2009 Volume: 12 Issue: 1 Pages: 9-17
Publisher: University of Kufa جامعة الكوفة

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Background: the role of infection with Helicobacter pylori (H. pylori) as a risk factor for acute myocardial infarction is controversial.Aim of the study: to assess the association between H. pylori infection and acute myocardial infarction. Patients and Methods: the IgG seropositivity to H. pylori was assessed in 40 patients with acute myocardial infarction and 39 controls. Results: in the total study the association was statistically insignificant (80% vs 69.2%, p value:0.2, OR 0.56, 95%CI(0.2-1.5)), but in those below the age of 50 years was significant (100% vs 66.7%, p value: 0.04, OR 2.3, 95%CI(1.4-4.02)). No association was found between H. pylori seropositivity and worsening of the classic coronary risk factors. Conclusion: this study suggests that H. pylori infection is a risk factor for coronary artery disease in patients below 50 years.

تمهيد: إن دور الإصابة بالهليكوباكتر بايلوري كعامل خطورة للإصابة بإحتشاء العضلة القلبية الحاد هو محل خلاف0 الأهـداف: تقييم العلاقة بين الإصابة بالهليكوباكتر بايلوري وبين احتشاء العضلة القلبية الحاد0 الطرق: في هذه الدراسة ذات مجموعة الضبط حُددت الموجبية المصلية للغلوبيولين المناعي جي المضاد للهليكوباكتر بايلوري عند 40 مريضاً مصاباً باحتشاء العضلة القلبية الحاد وعند 39 شخصاً من مجموعة الضبط0 النتائج: لم تكن النتائج معتبرة إحصائياً في عموم الدراسة (80% مقابل 69٫2% وكانت قيمة p 0٫2 وOR 0٫56 و95% CI (0٫2-1٫5))، ولكنها كانت معتبرة عند الأشخاص دون سن الـ 50 سنة (100% مقابل 66٫7% وقيمة p :0٫04 وOR 2٫3 و95% CI (1٫4-4٫02)). ولم تظهر هناك علاقة بين الموجبية المصلية للهليكوباكتر بايلوري وبين احتداد عوامل الخطورة الكلاسيكية لأمراض الشرايين التاجية0الإستنتاجات: إنّ هذه الدراسة تبيّن أنّ الإصابة بالهليكوباكتر بايلوري هو عامل خطورة لأمراض الشرايين التاجية في المجموعة العمرية التي هي دون الـ 50 سنة.


Article
The Impact of Inflammation on Adiponectin, IL-6 and CRP in Acute Myocardial Infarction Patients

Authors: lmmmA Esmaeel Ibrahim --- Hadef Dhafer EL-Yassin --- Hamid Kareem Sachit AL-Janabi.
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: supplement Pages: 616-622
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Adipose tissue is increasingly recognized as a key regulator of energy balance, playing an active role in lipid storage and buffering, and synthesizing and secreting a wide range of endocrine products that may be directly involved in the pathogenesis of the complications associated with obesity. Adiponectin is adipocyte derivate hormone that has important effect as anti-inflammatory factor. Inflammation contributes across the spectrum of cardiovascular disease, including the earliest steps in atherogenesis. IL-6 is one of the most important mediators of fever and of the acute phase response. C-reactive protein (CRP) is a protein found in the blood, the levels of which rise in response to inflammation (an acute-phase protein). Myocardial Infarction (MI) or Acute Myocardial Infarction (AMI), is the interruption of blood supply to part of the heart, causing some heart cells to die.OBJECTIVE:To investigate the level of adiponectin and its effect on IL-6 and CRP in patients with Acute Myocardial infarction.SUBJECTS AND METHODS:The study included 50 patients with Acute Myocardial infarction and forty healthy subjects as control group. Levels of adiponectin , CRP and IL-6 were measured.RESULTS:The levels of adiponectin, IL-6 and CRP were significantly elevated with (p<0.001), there was negative correlation between adiponectin with CRP and IL-6 in acute myocardial infarction patients.CONCLUSION:The significant increase in adiponectin in AMI may be related to inflammation. Adiponectin inversely correlated with inflammatory marker (CRP and IL-6) so it has anti-inflammatory properties and that make us consider it as cardiovascular protective factor


Article
Cardiogenic Shock Complicating Acute Myocardial Infarction; Aetiology, Treatment and Prognosis

Author: Shokry F. Nassir
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2017 Volume: 10 Issue: 2 Pages: 2771-2784
Publisher: Kerbala University جامعة كربلاء

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background: Cardiogenic shock is the leading cause of death in patients hospitalized for acute myocardial infarction. Treatment strategies using intra-aortic balloon counter pulsation and emergency revascularization by percutaneous coronary interventions or coronary bypass surgery have been shown to improve outcomes.Aim: to provide an overview of patients with cardiogenic shock complicating acute myocardial infarction admitted to Ibn Al-Bitar center for cardiac surgery in Baghdad. Methods: This is a prospective observational study conducted at Ibn Al-Bitar center for cardiac surgery in Baghdad. The criteria of the British cardiovascular intervention society were used to identify patients who were admitted to the hospital within one year period with the main focus of the study was on patients with cardiogenic shock complicating acute myocardial infarction. Full clinical assessment was done at bedside. Twelve leads electrocardiography and basic biochemical tests were obtained and echocardiography was done for every patient. Results: During a period of one year from March 2010 through March 2011 One hundred seventeen patients with cardiogenic shock were identified. Acute myocardial infarction accounted for shock in 78(66.7%). In this patients population there were good percentages of history of myocardial infarction, hypertension, diabetes and smoking. Anterior ST–elevation myocardial infarction was found in two-thirds of them. Predominant left ventricular failure caused cardiogenic shock in 54(69.2%), while ventricular septal rupture, acute mitral regurgitation and right ventricular failure accounted for the rest. The overall mortality rate of cardiogenic shock was 64 (82.1%). Intra-aortic balloon pumping (IABP) was placed in 28 (35.9%) and Thrombolytic therapy was used in 19 patients (24.4%), while Both IABP and thrombolytic therapy were used in 8 (10.3%). Coronary angiography was done in 18 (23.07%). Percutanous coronary intervention was used in 10 (12.8%), while coronary artery bypass grafting was done in 3(3.8%) of the patients. Conclusions: This study shows a high in-hospital mortality for patients with cardiogenic shock complicating acute myocardial infarction and despite the proven benefit of revascularization procedures there were only few patients had undergone these Procedures. The utilization rates of thrombolytic therapy and intra-aortic balloon pump were also low.


Article
Plasma fibrinogen and D-dimer in patients with acute myocardial infarction

Author: Muna A. Kashmoola منى كشمولة
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2005 Volume: 31 Issue: 2 Pages: 70-73
Publisher: Mosul University جامعة الموصل

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Abstract

Objectives: To investigate the plasma fibrinogen level and D-dimer reaction in patients with acute myocardial infarction (AMI) together with other haematological parameters.
Design: A prospective clinico-haematological study.
Setting: Intensive coronary care unit in Ibn-Sina teaching hospital in Mosul during a period of 4 months from October 2004.
Participants: Forty patients with acute myocardial infarction together with a control group of 40 subjects.
Main outcome measures: Basic haematological parameters, plasma fibinogen level and plasma D-dimer reaction tests. Biochemical tests including cardiac enzymes measurement as creatine kinase (CK) and asparate transaminase (AST) were performed.
Results: Plasma fibrinogen level, white blood cell count and neutrophils count were significantly higher in patients compared to control group with P values (<0.05) (<0.01) and (<0.05) respectively. Positive plasma D-dimer reaction was significantly more frequent in patients than in control group (p<0.05). High plasma fibrinogen level and positive plasma D-dimer reaction were seen in those with worse outcome with p-value (<0.05), (<0.05) respectively. Plasma fibrinogen was significantly higher in those with extensive infarction compared to others (p<0.05).
Conclusion: High plasma fibrinogen and positive plasma D-dimer reaction were more frequently seen in patients with complicated course of myocardial infarction.

Key words: Fibrinogen, D-dimer, acute myocardial infarction.


Article
Helicobacter Pylori Seropositivity and Acute Myocardial Infarction

Author: Wathiq K. Abdul-Gafour واثق عبد الغفور
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2011 Volume: 7 Issue: 2 Pages: 9-15
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Acute myocardial infarction (AMI) is one of the most common diagnoses in hospitalized patients. The stimulus that initiates the acute inflammatory process in AMI has not been identified. Conventional risk factors account only for approximately half of the patients with clinically apparent atherosclerosis which can leads to AMI. Recently a potential link between infectious agents and atherosclerosis has been suggested Objective: To find a possible association between Helicobacter pylori (H. Pylori) infection and AMI. Method: We studied the prevalence of anti-H. pylori antibodies in 94 patients who were admitted with the diagnosis of AMI and a similar number of healthy individuals who were age and sex matched. This was done using ELISA technique. Results: Overall prevalence of anti-H. pyroli antibodies in patients with AMI was 82.9% whereas the prevalence in the control group was 78.7% . This difference yielded an odd ratio of 1.317. Chi square test shows that this difference was insignificant statistically (p-value 0.458) Conclusion: We feel that our results do not support the hypothesis which stated that chronic infection with H. pylori is a major risk factor for AMI.


Article
The Association between Adiponectin, Insulin and Troponin I in Patients with Acute Myocardial Infarction

Authors: Ammal Esmaeel Ibrahim --- Hadef Dhafer El-Yassin --- Hamid Kareem Sachit Al-Janabi
Journal: Al-Nahrain Journal of Science مجلة النهرين للعلوم ISSN: (print)26635453,(online)26635461 Year: 2012 Volume: 15 Issue: 3 Pages: 15-22
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Adipose tissue is increasingly recognized as a key regulator of energy balance, playing an active role in lipid storage and buffering, and synthesizing and secreting a wide range of endocrine products that may be directly involved in the pathogenesis of the complications associated with obesity the most important adiposcyte deviated hormone is adiponectin. Insulin is a hormone that is central to regulating the energy and glucose metabolism in the body. Troponin is a complex of three regulatory proteins that is integral to muscle contraction in skeletal and cardiac muscle.This study was conducted during the period from Decenber2009 to April 2010, includes fifty patients with Acut Myocardial Infarction (AMI) were admitted to Cardiac Care Unit (CCU) at Medical City Teaching Hospital and Ibn –ALbetar Hospital in Baghdad. Levels of adiponectin, insulin and troponin were measured by ELISA method.The levels of adiponectin, insulin and troponin were significantly elevated with (p<0.001), A negatively significant correlation between adiponectin with insulin and troponin in acute myocardial infarction patients was found.Adiponectin was negatively associated with insulin in patients with AMI

النسيج الدهني يُعْرَفُ على نحو متزايد كمنظّم رئيسي لميزانِ الطاقةِ، يَلْعبُ دوراً نشيطاً في خزنِ الدهون و ويفرز تشكيلة واسعة من المُنتَجاتِ الإفرازيةِ التي قَدْ تُشتَركُ في النشوء المرضي لكثير مِنْ التعقيداتِ المرتبطة بصورة مباشرة بالسمنةِ من اهم المركبات التي يفرزها النسيج الدهني هرمون adiponectin. الأنسيولين هو الهورمون الذي ينظيم أيضِ الجلوكوزَ والطاقةَ في الجسمِ. Troponin هو مركّب مِنْ ثلاثة بروتينِات تنظيم الإنكماشِ العضلي في العضلات الهيكليةِ والقلبيةِ.تَضمّنتْ الدراسةُ 50 مريضُ بالذبحة الصدرية اما المجموعة المسيطرة فقد تضمنت أربعون من الأشخاص الأصحاء. مستويات adiponectin والأنسيولينِ و troponin تم قياسهامستويات adiponectin والأنسولين و troponin كانت مرتفة بشكل معنوي (p <0.001)، كان هناك إرتباطُ سلبي ُبين adiponectin والأنسولين و troponin في مرضى الذبحةّ الصدرية.وجود زيادة معنوية في مستويات adiponectin، في مرضى الذبحةّ الصدرية وهذه قَد تكون مُتَعَلّقة بالالتهاب. هنالك علاقة عكسية بينadiponectin والأنسولين.


Article
The Rate and Prognosis of Ventricular Fibrillation Complicating Acute Myocardial Infarction

Author: H. A. Nasrallah حسن علي نصرالله
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2006 Volume: 1 no. 1 Pages: 1-7
Publisher: Kerbala University جامعة كربلاء

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Objective: To determine the rate of ventricular fibrillation according to thetime of onset of ischemic chest pain of patients with acute myocardialinfarction.Design: Prospective observational study.Setting: The only general hospital in Karballa city.Patients: 146 consecutive patients admitted to the coronary care unit withacute myocardial infarction.Main outcome measures: Time of onset of chest pain and ventricularfibrillation and survival of patient admitted with myocardial infarction. duringhospitalization.Results: The rate of ventricular fibrillation in these patients was high in thefirst 4 hours from onset of pain (14 patients 77.8%) and decline afterward,11.1% of patients with V.F. died during hospitalization compared with 7.8%of those without.Conclusion: Early admission to hospital of patient with acute myocardialinfarction will reduce the early mortality due to ventricular fibrillation. Fasteraccess to facilities for resuscitation must be achieved if major improvement inthe persistently high mortality of patient with acute myocardial infarction. is tobe made.

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