A Study on Acute Myocardial Infarction in Women

INTRODUCTION: The twentieth century saw unparalleled increase in life expectancy and a major shift in the cause of illness and death throughout the world. During this transition cardiovascular disease became the most common cause of death worldwide. A century ago CVD accounted for less than 10% of all deaths. Today it accounts for approximately 30% of deaths worldwide including nearly 40% in high-income countries and 28% in low and middle-income countries. Driven by industrialization and associated lifestyle changes, this ongoing transition is occurring around the world among all races, ethnic groups and cultures at an even faster rate than last century. Based on data from Framingham heart study, the lifetime risk of developing symptomatic CAD after age forty is 49% for men and 32% for women. The World Health Organization has estimated that by 2020, the global number of deaths from CAD will have risen from 7.2 million in 2002 to 11.1 million. The evaluation of IHD in women presents a unique and sometimes difficult challenge for clinicians, owing to the difference in symptoms, clinical features and mortality as compared to men. The diagnosis and treatment of CHD have been primarily based on research conducted in men, either excluding women entirely or including limited number of women. The use of traditional risk factors assessment was limited in prediction of CAD in women. The compendium of coronary heart disease data indicate that current research and strategy development must focus on gender-specific issues in order to address the societal burden and costs related to these demographic shifts in IHD that place women in the majority of those impacted. This significant burden of the disease in women places unique diagnostic, treatment, and financial encumbrances on our society that are only further intensified by a lack of public awareness about the disease on the part of patients and clinicians alike. This societal burden of the disease is, in part, related to our poor understanding of gender-specific pathophysiologic differences in the presentation and prognosis of IHD and the paucity of diagnostic and treatment guidelines tailored to phenotypic differences in women. This study is to analyse the clinical presentation, complications and outcome in those women who presented with myocardial infarction. AIM OF THE STUDY: 1. To analyse the various risk factors in women with acute myocardial infarction. 2. To study the presenting features, site of infarction and complications of acute myocardial infarction in women. 3. To study the outcome in women with acute myocardial infarction admitted to coronary care unit. MATERIALS AND METHODS: Hundred women admitted with acute myocardial infarction in coronary care unit of Government General Hospital were randomly selected for the study for a period of one year from July 2008 to June 2009. Persons included in the study were informed about the aim of the study and consent was obtained. Information like age, symptoms, time interval to reach hospital, associated comorbid conditions such as hypertension, diabetes, coronary artery disease, family history, menstrual status, complete clinical examination and treatment details were collected. Investigations like electrocardiogram, echocardiogram, renal function test, lipid profile were also done. All the patients were followed up during their hospital stay and the outcome recorded. The collected data were analysed with regards to age of presentation, menstrual status, symptoms, time to reach hospital since the onset of symptoms, severity of clinical presentation according to Killip’s classification, electrocardiographic changes and echocardiographic changes with in hospital outcome. Pump failure is now the primary cause of in hospital death due to STEMI. The extent of infarction correlates well with the degree of pump failure and with mortality both early and later2. OBSERVATIONS: Among the hundred women selected for the study, 21 were in the age group of 50 and below, 33 were in the 51 to 60 age group, 22 were in the 61 to 70 age group and 24 were in the age group of above 70. This is shown in Table 1 and Figure 1. The mean age is 60.97 and the range is 35 – 85. CONCLUSION: 1. Women with advanced age have a poorer outcome. 2. Women clinically present with atypical symptoms that has resulted in a significant delay to reach treatment centre. 3. In hospital mortality is directly related to atypical symptoms, delay in reaching the hospital and co morbidities