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

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