Unrecognized dyslipidemia among patients presented with first attack of acute coronary syndrome [ACS] in a multiethnic population in GMC hospital, Ajman, UAE [Dyslipidemia-ACS UAE Study]

Introduction: Acute coronary syndrome [ACS] is a major reason for hospitalization in our country. Dyslipidemia has been identified as one of the major modifiable risk factors for Coronary Artery Disease [CAD]. Our clinical observation was that many patients presenting with first ACS in Ajman, had no known risk factors, yet their routine investigations revealed lipid derangements. The aim of this study was to determine the prevalence of unrecognized dyslipidemia and its relation to other modifiable risk factors in an Ajman cohort of patients with first ACS

Materials and methods: All patients who visited the Department of Cardiology during the period of January 2006 to December 2012 with first attack of ACS without history of previous coronary artery disease or dyslipidemia were studied through a descriptive epidemiological approach. Case records of these were first reviewed, data collected and questionnaires were filled. From this, data was entered into excel spread sheet and was transformed to SPSS 21 version for statistical analysis

Results: A total of 438 case records were studied and 169 patients met inclusion criteria. Out of these, 141 patients [83.4%] were unrecognized dyslipidemics and 28 patients [16.6%] were non-dyslipidemics. We documented the demographic and clinical characteristics of the 141 unrecognized dyslipidemics along with other comorbid conditions. We found that most of the patients [54/141, 38.3%] were less than 40 years, 40/141 [28.4%] were between 41-50 years, and 47/141 [33.4%] were above 50 years. Majority of our patients were males [109/141, 77.3%], and Asians [74/141, 54%] were the major ethnic group being affected, followed by the Arabs [52/141, 38%]. We also found that smoking was the most common risk factor encountered in our population [57/141, 40.4%], followed by family history of early coronary artery disease [40/141, 36.7%], hypertension [47/141, 33.3%] and diabetes [29/141, 20.6.%]. 82 patients out of the 141 patients presented with high systolic and diastolic BP. During presentation non ST-segment elevation-ACS was a more frequent diagnosis [120/141, 85.1%] than ST-segment elevation myocardial infarction [13/141, 9.2%] or unstable angina [8/141, 5.7%]. The LDL levels >100 mg/dl in majority [123/141, 88.6%] of the patients

Conclusion: Dyslipidemia was one the major risk factors which was widely prevalent and it went unrecognized until being detected during the first presentation with ACS. There were also other risk factors which contributed to the presentation of ACS at a young age, especially in males. This research implied the importance of creating more awareness and maintaining strict control of lipid levels in at risk patients. It provides useful information to health authorities, to design locally relevant interventions

Recurrent venous thrombo-embolism in a young adult female: case report with review of literature

Venous thromboembolism [VTE], including both deep vein thrombosis [DVT] and pulmonary embolism [PE] is the third most common cardiovascular illness after acute coronary syndrome and stroke. VTE is a multi-causal disease that results from multiple interactions between genetic, acquired, and circumstantial risk factors. A 31 year old female patient presented with acute DVT at six weeks of her second pregnancy. She was managed accordingly with low-molecular weight Heparin throughout pregnancy; however, she developed multiple DVTs during the peri-partum period, after discontinuing thetreatment for one week. Thrombophilia screening revealed that she has two strong thrombophilic states: Factor V Leiden and Protein S deficiency, in addition to other circumstantial risk factors [Obesity and Dyslipidemia]. The combination of these two inherited diseases presents a challenge to the treating physician, especially during pregnancy. In this article, we discussed this clinical case and the management plan that was followed with her till the current time with a review of literature in the same context. We believe that addressing VTE as a public health problem should take a multidimensional approach targeting the epidemiology of the disease with implementation of cost-effective preventive and therapeutic programs

Tobacco use among patients with cardio-vascular diseases: a hospital based study, Ajman, UAE

Background: The proportion of deaths from coronary heart disease varied from 25 to 45% in the Eastern Mediterranean region and has become a major public health threat in the region

Objectives: The use of tobacco among patients with cardiovascular diseases reporting to the departments of Cardiology and Internal Medicine at GMC Hospital Ajman, UAE and the attitude of patients with cardiovascular diseases towards use after diagnosis was assessed

Materials and Methods: This cross-sectional study was conducted amongst 300 patients with cardiovascular diseases reporting to the Out-patient and In-Patient of departments of Cardiology and Internal Medicine of GMC Hospital Ajman, UAE. An interviewer-administered questionnaire was used for data collection. SPSS-21 version was used to perform statistical analysis. The proportion of tobacco users was estimated. The participants were divided into smokers and non-smokers and the association between smoking habits and sociodemographic variables, and clinical conditions were assessed

Results: Out of 300 participants, 194[64.7%] were between age 30 and 50 years, and 225[75%] were males. The Highest number 146[48.7%] was found to be from the Eastern Mediterranean region. Among the 300 participants, 142[47%] used tobacco. Amongst the 142 tobacco users, 40[28.2%] of them consumed shisha with an average age of initiation being 25 years and the average consumption before and after CVD being once daily. For cigarette smoking, there were 125[88%] participants with an average age of initiation of 20 years, while the average quantity before CVD being fifteen in a day, which decreased to five in a day after CVD. Of the participants, 1[0.7%] was found to use Dokha, starting after CVD at the age of 45, consuming five in a day. The most consumed type of tobacco among males is cigarette as nearly 120 participants smoked. Males accounted for almost 96% of total smokers. On the other hand, the most consumed type of tobacco among females is shisha; nearly 15% of shisha smokers were female, whereas males accounted for 85%. Eight participants were found to have only arrhythmias and 4 [50%] were consumers of tobacco products. Four participants had only angina pectoris and 3 [75%] out of those 4 consumed tobacco. Ninety eight participants had dyslipidemia alone, out of which, 42 [42.9%] were tobacco users. Ninety-five participants had combined disease effect, of those, 50 [52.6%] were found to consume tobacco products. There was a significant association between tobacco use in patients with cardiovascular diseases and gender

Conclusion: The proportion of tobacco use among the participants with cardiovascular disease was 47.3%. Cigarette had the highest consumption rate out of all the other forms of tobacco. There was a significant association between tobacco use in patients with cardiovascular diseases and gender. Smoking was found to be more prevalent among males than females. Among males, cigarette smoking was more common while in females the use of shisha was more common

unusual diagnosis for chest pain - Takotsubo cardiomyopathy: a case report

Takotsubo Cardiomyopathy or Stress Cardiomyopathy is non-ischaemic cardiomyopathy which mimics acute coronary syndrome [ACS]. It is becoming an increasingly reported condition, accounting for approximately 2% of all suspected cases of ACS. It is a well-recognized cause of acute heart failure, lethal ventricular arrhythmias, and ventricular rupture. Herein, we describe a patient who exhibited this syndrome and we review the existing literature on this condition and its associations. The case is about a 35 year old female who developed severe chest pain one hour following a normal vaginal deliver of twin babies. In view of her electrocardiogram and cardiac biomarkers, she was immediately diagnosed and managed as a case of ACS. But her subsequent investigations revealed a diagnosis of Takotsubo Cardiomyopathy. Her coronary angiography was normal and her echocardiogram which initially showed significant LV dysfunction improved drastically within a few weeks

Asymptomatic dissecting aortic aneurysm in a young adult: a case report

Aortic dissection is generally considered as a rare condition when compared to other common cardiovascular diseases, yet it is potentially fatal. We review here a case of a 37-year old asymptomatic male patient who appeared for routine checkup as he was concerned that seven of his family members were diagnosed with aortic aneurysm and some of them had progressed into aortic dissection. He had a history of hypertension that was generally controlled with medications. Although the patient was entirely asymptomatic, the diagnosis of a dissecting aortic aneurysm was confirmed. The aneurysm was confined entirely to the ascending thoracic aorta. The clinical presentations, diagnosis and management of ascending aortic dissection will also be reviewed. It has to be noted that early and accurate diagnosis and treatment of such a potentially lethal condition are essential for survival. Long term follow up is also required as there is always a risk of recurrence