Cardiovascular disease, including ischemic heart disease, is one of the most common causes of death and disability in both sexes. The traditional concept of ischemic heart disease as a “man’s disease” is debunked. Yentl syndrome is used to describe the underdiagnosis of ischemic heart disease in females and its associated effects. This article reports a 48-year-old female presented to the emergency department with acute epigastric discomfort. Her initial diagnostic tests did not reveal any abnormalities, and she was discharged. Subsequently, after four days, she again visited the emergency department with chest pain, the evaluation of which furthermore revealed no abnormalities. However, we admitted her. After 40 hours of hospitalization, her evaluation revealed anterior wall ST elevation myocardial infarction, and she underwent emergent reperfusion via coronary catheterization. This combination of atypical signs and symptoms and chances of delayed manifestations in the diagnostic investigations provides evidence for a need for thorough assessment in a female with chest pain.
Surgical aortic valve replacement has remained the gold standard therapy for symptomatic severe aortic stenosis patients for decades. However, in past decade transcatheter aortic valve implantation has been an alternative to surgical aortic valve replacement in patients with symptomatic severe aortic stenosis who are not suitable for open heart surgery. We report first case of transcatheter aortic valve implantation in Nepal in an 80-year-old female with symptomatic severe AS who was successfully treated and had good functional and hemodynamic results at one-months follow-up.
Background and Aims: Acute coronary syndrome is an important health issue. There is paucity of its data in late elderly. We aimed to study their clinical profile and prevalence of conventional risk factors. Methods: Descriptive cross-sectional study conducted at Shahid Gangalal National Heart Centre from February 2022 to May 2022 including 71 consecutive patients of acute coronary syndrome of age >75 years. They were evaluated focusing their chief complaints and cardiovascular risk factors. Results: Mean age was 80.32±4.06 years. Forty (56.33%) were male and 31 (43.66%) were female. Thirty-nine (54.92%) were hypertensive, 29 (40.84%) were diabetic, 18 (25.35%) were smoker, 10 (14.08%) had history of dyslipidemia and 6 (8.45%) had family history of cardiovascular disease. Chest pain was present in 54 (76.05%), dyspnea in 28 (39.43%), sweating in 15 (21.12%) and nausea/vomiting in 8 (11.26%). Palpitation was present in 7 (9.85%), and epigastric pain in 13 (18.30%). Seven (9.85%) gave history of pre-syncope/ syncope and 6 (8.45%) had altered mental status. There was significant correlation of smoking (p=0.02) and types of ACS (p=0.001) with gender. Conclusion: Acute coronary syndrome were plausibility common in late elderly female. Chest pain was commonest complaint in both genders. Dyspnea, sweating and epigastric pain were also common. Pre-syncope/ syncope and altered mental status were also present in some cases. Conventional risk factors were quite common in both genders. These symptoms can be features acute coronary syndrome in elderly hence should be evaluated cautiously.
Background and aims: Electrocardiogram of acute ST elevation inferior myocardial infarction can show concomitant ST depression in anterior leads. We aimed to see its significance on coronary angiogram. Methods: Cross sectional study conducted in Department of Cardiology of Shahid Gangalal National Heart Centre from March 2021 to June 2021. Total of 64 patients of acute inferior myocardial infarction were included consecutively. Electrocardiogram were analyzed for the presence of ST depression in anterior leads (V1-V6). Coronary angiogram were obtained. Linear regression analysis was applied to see correlations. Results: Thirty-four (53.12%) participants had significant ST depression in anterior leads. Their mean age was 64.53±11.67 years. Twenty-two (64.70%) were male. Out of them, 13 (38.23%) were hypertensive, 9 (26.47%) were smoker and 7 (20.58%) were diabetic. Among 30 (46.88%) participants without ST depression, mean age was 56.73±13.31 years and 21 (70%) were male. Out of them, 11 (36.66%) were hypertensive, 12 (40%) were smoker and 11 (33.66%) were diabetic. Culprit vessel was right coronary artery in 22 (64.70%) of those with ST depression and 22 (73.33%) of those without ST depression. Significant left anterior descending artery lesion was seen in 19 (55.88%) of those with ST depression and 3 (10%) of those without depression. Anterior ST depression showed positive correlation with left anterior descending artery lesion. Conclusion: ST depression in anterior leads in acute inferior myocardial infarction can be due to presence of concomitant left anterior descending coronary artery disease.
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