Clinical Profile of ST Elevation Myocardial Infarction in Females

INTRODUCTION: Cardiovascular disease is the leading cause of death among women, regardless of race or ethnicity, and causing the deaths of 1 in 3 women; this amounts to more deaths from heart disease than from stroke, lung cancer, chronic obstructive lung disease, and breast cancer combined. Despite these sobering statistics and estimates that a 40-year-old woman has a lifetime risk of cardiovascular disease of 32 percent, and although awareness of cardiovascular disease as the leading cause of death has increased, still only about 55 percent of women identify cardiovascular disease as their greatest health risk. Although mortality from heart disease has declined gradually among men since 1979 (by 30 to 50 percent), mortality from heart disease in women has increased during that same period. For coronary heart disease in specific, mortality rates have fallen for both men and women over this time period, but much more rapidly in men than women. A greater proportion of women (52 percent) than men (42 percent) with myocardial infarction die of sudden cardiac death before reaching the hospital, and two thirds of women who suffer a myocardial infarction never completely recover. Thus, understanding even subtle differences between men and women in development or progression of cardiovascular disease, use of proven therapies, and response to therapy is paramount. Experts in industrialized societies have long recognized that the first presentation with coronary heart disease occurs approximately 10 years later among women than men, most commonly after menopause. The worldwide interheart Study, a large cohort study of more than 52,000 individuals with myocardial infarction, first demonstrated that this approximate 8- to 10-year difference in age of onset among men compared with women holds widely around the world, across various socioeconomic, climatic, and cultural environments. Although coronary artery disease in general manifests earlier in less well-developed countries, the approximate 8 to 10 year age gap in time of onset between men and women is universal. Despite this delay in onset, mortality from coronary heart disease is increasing more rapidly among women than men in both the developed and developing world. AIM OF THE STUDY: 1. To study the various presenting features of ST Elevation Myocardial Infarction (STEMI) in female pts. 2. To identify important risk factors of ST Elevation Myocardial Infarction (STEMI) in our study population. MATERIALS AND METHODS: The study was conducted at intensive cardiac care unit of Govt. Stanley Hospital, Chennai during July 2009 to November 2009. • This study was done as a descriptive study. • Ninety female patients admitted with clinical features and ECG changes suggestive of ST segment elevation myocardial infarction, elevated CK-MB taken as cases. Inclusion Criteria: - Female patients admitted with the clinical features and ECG changes suggestive of STEMI. Exclusion Criteria: - Female patients with unstable angina, NSTEMI (Non STEMI). - Female patients with ST elevation without both symptoms and enzyme elevation. • Ninety patients were examined and detailed history with regard to history risk factor analysis was made. • Baseline investigations like complete blood count, renal function test, Urine routine examination, Chest x ray and ECG were taken. • In this study, clinical symptoms like chest pain and association with sweating, palpitation, nausea, vomiting and breathlessness were all taken into account and percentage of each was studied. • Physical signs like hypertension, hypotension, raised JVP, S3, S4, crackles and wheeze were all looked for. • Hypertension was considered by documentary history of hypertension on medication or BP >140/90 mmHg. • Diabetes mellitus was considered either by documentary history of treatment or fasting blood sugar >126mg/dl and postprandial blood sugar >200mg/dl. • Serum cholesterol was done for all patients and lipid profile was also done. OBSERVATIONS: Clinical presentation-Symptoms: • 79% (71 out of the 90 patients) of the patients with ST elevation MI had mild to severe chest pain. The character of the pain was assessed to be squeezing or compressing in nature with characteristic radiation in 27% of the 71 patients. • 21% of the patients (19 out of the 90 patients) presented only with breathlessness without chest pain. • One patient presented with cerebro vascular accident (CVA). In our study, out of 90 patients, 19 patients were presented without typical chest pain. In our study, most of the patients presented with Killip Class I. Out of the 90 patients, 58 patients presented with Killip class I and 20 patients were in Class II. In our study, 48 patients (53%) were thrombolysed and 42 patients (47%) were not Thrombolysed. Incidence of non-thrombolysis due to various reasons increases with the age. 55% of female with age 75 and above were not thrombolysed, compared to 40% in women in age 60 and less than 60 yrs. Incidence of myocardial infarction increases with the age. In our study 67% of the patients were in the age of >60 yrs. In our study, 58% population (52 out of the 90 patients) found to have diabetes. Prevalence of smoking and alcohol in our study was zero percent. In our study, Anteroseptal and anterior wall myocardial infarction were the two common type of myocardial infarction. CONCLUSION: The following are conclusions that could be inferred from this study on clinical spectrum and risk factors among female patients. • The most common symptom is chest pain. • Atypical symptoms are more common in older females and diabetic patients. • The most common cardiovascular sign is crackles. • Most of the patients belonged to Killip Class-I. • Most common age group affected was above 60yrs and showing that risk of myocardial infarction increases proportionately with age. • Diabetes is clearly related to risk of myocardial infarction. • Both obesity and hypertension are also associated with increased risk of myocardial infarction in female population. • Most of the patients with myocardial infarction have dyslipidemia. • Most common type of myocardial infarction is anteroseptal myocardial infarction (ASMI)