Age and its relationship to acute coronary syndromes in the Saudi project for assessment of coronary events [SPACE] registry: the SPACE age study

To characterize risk profile of acute coronary syndrome [ACS] patients in different age groups and compare management provided to in-hospital outcome. Prospective multi-hospital registry. Seventeen secondary and tertiary care hospitals in Saudi Arabia. Five thousand and fifty-five patients with ACS. They were divided into four groups: /= 70 years. Main outcome measures: prevalence, utilization and mortality. Ninety-four percent of patients <40 years compared to 68% of patients >70 years were men. Diabetes was present in 70% of patients aged 56-70 years. Smoking was present in 66% of those <40 years compared to 7% of patients >70 years. Fifty-three percent of the patients >70 years and 25% of those <40 years had history of ischemic heart disease. Sixty percent of patients <40 years presented with ST elevation myocardial infarction [STEMI] while non-ST elevation myocardial infarction was the presentation in 49% of patients >70 years. Thirty-four percent of patients >70 years compared to 10% of patients <40 years presented >12 h from symptom onset with STEMI. Fifty-four percent of patients >70 compared to 64-71% of those <70 years had coronary angiography. Twenty-four percent of patients >70 compared to 34-40% of those <70 years had percutaneous coronary intervention. Reperfusion shortfall for STEMI was 16-18% in patients >56 years compared to 11% in patients <40 years. Mortality was 7% in patients >70 years compared to 1.6-3% in patients <70 years. For all comparisons [p < 0.001]. Young and old ACS patients have unique risk factors and present differently. Older patients have higher in-hospital mortality as they are treated less aggressively. There is an urgent need for a national prevention

Cor triatriatum with persistent levoatrial cardinal vein late presented as severe mitral stenosis

Cor triatriatum is a rare congenital cardiac anomaly that usually becomes symptomatic in the first years of life. We present a 28-year-old pregnant female patient presented with shortness of breath, palpitations and decreased exercise tolerance. Transthoracic [TTE] and transesophageal [TEE] echocardiography showed cor triatriatum, features of severe mitral stenosis and atrial septal defect [ASD]. The patient underwent successful surgical correction with an uneventful postoperative course.

Usefulness of Tei index in patients with rheumatic mitral regurgitation and apparently normal left ventricular ejection fraction

Rheumatic mitral regurgitation is rather common in developing countries. It usually progresses insidiously, because the heart compensates for increasing regurgitant volume by left-atrial enlargement, causes left-ventricular overload and dysfunction, and yields poor outcome when it becomes severe. Doppler-echocardiographic methods can be used to quantify the severity of mitral regurgitation. It is known that ejection fraction underestimates the presence of left ventricular dysfunction in these patients. This study aimed to study global cardiac function of these patients by using LV Tei index. One hundred patients with rheumatic mitral regurge predominantly were included [40 males and 60 females; aged 10-24 years, median 20.6 years]. All participants were subjected to full echocardiographic study including total isovolumic index [Tei index =isovolumic relaxation time IRT +isovolumic contraction time ICT/ejection time ET] for the left ventricle. Special attention was paid to grading of severity of the mitral regurgitation. LV ejection fraction was preserved in all cases but, however, the total left isovolumic index was prolonged 0.56 +/- 3 in 64 of them [34 females and 30 males] denoting masked LV dysfunction P <.00001. There was a correlation of increasing severity of dysfunction with the degree of mitral regurgitation. Ejection fraction underestimates the presence of left ventricular dysfunction in these patients. However, this was unmasked by the Tei index which could be an additive data for detecting early left ventricular dysfunction