RISK FACTORS AND PECULIARITIES OF THE COURSE OF ACUTE MYOCARDIAL INFARCTION AMONG YOUNG ADULTS

RISK FACTORS AND PECULIARITIES OF THE COURSE OF ACUTE MYOCARDIAL INFARCTION AMONG YOUNG ADULTS

Bayram Hojakuliev

Doctor of Medical Science, professor of the hospital therapy, including endocrinology course, the State Medical University named after M. Garryyev,

Turkmenistan, Ashgabat

Mammetberdi Elyasov

Candidate of Medical Science, the Academy of Sciences of Turkmenistan, head of the medical sciences division,

Turkmenistan, Ashgabat

ABSTRACT

Depending on gender differences, men were more likely to have obesity and smoking. Arterial hypertension is an independent risk factor for myocardial infarction, but determines the more frequent presence of additional risk factors.

Keywords: Metabolic syndrome, obesity, diabetes mellitus, enzyme, dyslipidemia, systolic dysfunction, postinfarction angina.

Estimation of morbidity rate of coronary heart disease (CHD) amount young adults is a complex task, mainly for the reason that the latent form of the disease is the most common.  The Framingham Heart Study showed that the morbidity rate of myocardial infraction (MI) during 10-year observation amounted to 12.9 per 1 thousand of males aged between 30-34 and 5.2 per 1 thousand of females aged between 35-44 [1]. In other studies the share of the patients with IM aged below 40-45 amounted to 10% [2, 5]. In most cases IM among young adults is developed without preceding coronary medical history. Among 200 patients with documented angiographic coronary atherosclerosis, stable angina was observed in 24% of patients aged below 45 and in 51% of patients aged above 60, while acute coronary syndrome was diagnosed in 76% and 49% cases accordingly [3]. While analyzing the angiography data of the patients aged before 45, mainly single-vessel disease is observed [4, 6].

Study objective - study of risk factors, peculiarities of the course, structure of sequela of initial myocardial infraction in young adults whether or not suffering from arterial hypertension.

Documents and methods. Prospective and post evaluation analysis of 108 medical histories was conducted: the patients were admitted to the hospital ICU of the cardiology scientific clinical center during first hours of IM within the period from 2014 to 2020. IM was diagnosed in all patients given the presence of a typical clinical pattern, registered ST-segment elevation in two adjoining deflection at ECG, increased level of cardiac-specific enzymes. Depending on time of admission to a hospital, various types of myocard revascularisation were conducted. During first 24-hour period of IM: systemic thrombolytic therapy or initial transdermal interference (ITI) - angioplasty and stenting of coronary arteries; in case of more late admission - delayed ITI if indicated. The patients received standard therapy, which included: double antiplatelet therapy, β-adrenoceptor blocking agents, inhibitors of angiotensin converting enzymes, statins.

Statistical processing of obtained results was conducted using Statistica 6.0 application (StatSoft, Inc. 2001). Averages (M) are given in respect to standard deviation (SD). The results obtained at < 0.05 are considered statistically significant.

Results and their discussion 91 patients with initial IM (84.3%) were male and 17 (15.7%) were female.  Transmural myocardial damage was observed more often - in 103 patients (95.4%); non-transmural cases were observed in 5 (4.6%) patients.  According to ECG study, predominant distribution of IM of anteroseptal wall of left ventricle (LV) was observed in 46 (42.6%) patients; IM of other distribution type was observed in 62 (57.4%) patients (lower wall - in 52 (48.2%) patients, side wall - in 10 (9.3%) patients).  No gender differences were found at evaluation of IM distribution and pathologic wave Q. Males were younger (average age was 39±1.9) in comparison with women (average age was 44±1.2, p<0.01).

Among 108 patients: the temporarily unemployed amounted to 13 (12.0%) persons; the employed amounted to 95 (88.0%), among the latter: white-collar workers - 52 (54.7%) persons; manual labour workers - 43 (45.3%) patients. The most common risk factors were the following: male, arterial hypertension and smoking, which were observed in 88 (81.5%), 63 (58.3%) and 71 (65.7%) patients accordingly.  Influence of psychosocial parameters on disease development, such as stress and mental depression, were observed in 81 (75.0%) patients. Other factors determining the risk of IM were adiposis - in 53 (49.1%) patients, hereditary burden - in 32 (29.6%) patients, diabetes mellitus - in 4 (3.7%) patients, moderate lipidosis - in 23 (21.3%).  Depending on gender differences more common risk factors in males were adiposis - in 55 (60.4%) patients and smoking - in 70 (76.9%) patients. At the same time AH was registered in 65 (75.4%) patients, lipidosis - in 17 (18.7%) patients, diabetes mellitus - in 1 (1.1%) patient, hereditary burden - in 31 (34.1%) patients. The most common risk factors of CHD among women were the following: AH was observed in 11 (64.7%) patients, diabetes mellitus - in 2 (11.8%) patients, hereditary burden - in 4 (23.5%) patients, and moderate lipidosis - in 6 (35,3%) patients.

Analysis of risk factors of IM depending on AH presence showed that minor lipidosis is observed in young adults regardless of AH presence. In patients who underwent IM against increased AH values, the modifiable risk factors were more often adjusted by smoking or alcohol consumption in comparison with the patients with normal AH values. However, addiction to salt food had been steadily higher in the patients with AH. It is worth noting that commitment to treatment was lower in the patients with IM without AH. Metabolic syndrome as a risk factor of IM was observed more often in the patients with AH in consequence of more common adiposis and diabetes mellitus.

Therefore, AH is not only an independent risk factor of IM, but also determines more common presence of additional risk factors such as dyslipidemia, metabolic syndrome, hereditary burden by AH, addiction to salt food (Table 1).

Table 1.

Risk factors of myocardial infraction in young adults depending on presence of arterial hypertension

When studying peculiarities of clinical characteristics of myocardial infraction in young adults it was found out that in one fourth of cases IM does not fit into traditional canons, is of atypical nature, what significantly complicates differential diagnosis. Atypical manifestation of IM may resides in unusual pain distribution, its nature, irradiation, circumstances of occurrence or even in its absence, or in the presence of clinical signs common for diseases of other organs and systems. According to our data, 81 patients had anginal type of IM course, when pain is observed separately in the places of stenocardia irradiation: in neck, spine, left shoulder-joint, elbow joint, forearm, wrist, fingers, jaw bone, face, throat, teeth, and were perceived by the patients as an independent disease. Abdominal variant (in 7 patients with IM) was more commonly observed at posterior-diaphragmal distribution of the process and clinically imitates acute gastrointestinal disease, not uncommon - of surgical or contagious nature: intense pain in various places of stomach, dyspeptic disorders, possible diarrhea or flatulent distention, peritoneal signs, increased body temperature and rare gastrointestinal hemorrhage. Combined anginal-asthmatic variant (in 5 patients with IM) manifested not only in semicough at sharp walk, but also in escalation of cardiac failure symptoms. Arrhythmic variant (in 4 patients with IM) of the disease started with acute heart beat disorder or capacity at absence of pain syndrome: paroxysmal ventricular tachycardia or left bundle-branch block, which manifested in collaptoid state, syncope. Combination of cardiac failure with anginal variant (in 5 patients with IM) was accompanied by intensification of cardiac failure symptoms against severe pain syndrome. Asthmatic variant (in 3 patients with IM) was accompanied by acute left ventricular failure, what manifested in rapidly developing cardiac asthma attack, to the extent of pulmonary edema. Painless variant (in 3 patients with IM) was found at dispensary observation and was not accompanied by some clinical pattern. Cerebrovascular variant was not observed in any case.

 Table 2.

Characteristics of pain syndrome of myocardial infraction in young adults

Based on the obtained data it may be stated that atypical forms of acute cardiovascular condition can be observed in 25.0% of young adults (aged 25-45).

When analyzing clinical characteristics of the course of IM in young adults depending on the presence of AH, it was found that anginal variant of the course of IM in the patients with AH can be observed slightly more often in comparison with the patients without AH - in 56 (73.7%) and 22 (68.8%) patients accordingly (p>0.05), abdominal variant of the course was observed in the patients with AH - in 1 (1.3%) and 6 (18.8%) patients accordingly (p<0.05), combined anginal-asthmatic variant is more common in the patients with AH - in 4 (5.3%) and 1 (3.1%) accordingly (p>0.05). Arrhythmic variant of the course was more likely to occur in the patients with AH. Combination of cardiac failure and anginal variant was also more common in the patients with AH (p>0.05). Asthmatic, painless variant with atypical pain distribution was rare and didn’t differ considerably by frequency in the studied groups of patients (p>0.05).

Therefore, the most common risk factors were the following: male, arterial hypertension, smoking and psychosocial factors. Depending on gender differences more common risk factors in males were adiposis and smoking. AH is an independent risk factor of IM, but it determines more common presence of additional risk factors. Myocardial infraction in young adults usually runs with pain syndrome of various distribution, intensity, duration and irradiation and not uncommon with atypical forms.

We studied clinical and haemodynamic indicators in the patients with IM depending on the presence and absence of AH when admitting to a hospital.

Table 3.

Clinical and haemodynamic indicators of the patients with myocardial infraction when admitting to a hospital

Note. * - significance of differences between the groups at р< 0,05.

In the patients with AH post-infarction angina was observed significantly more common that without AH (p<0.05). Cardiac failure was registered significantly more common in the patients with AH. Differences in clinically significant heart rhythm disturbances and atrioventricular blocks are inauthentic. However, bundle-branch blocks were observed more common in the patients without AH (p<0.05).

When evaluating echocardiographic indicators it was found that end-diastolic volume (EDV), end-systolic volume (ESV), left atrial volume index (LAVI), thickness of interventricular septum and left ventricle posterior wall in the young patients with AH were higher than in the patients without AH (Table 4). The young patients with AH and IM had lower ejection fraction and zones of hypo- and akinesia and left ventricular systolic dysfunction were observed more common.

 Table 4.

Echocardiographic indicators in young adults with IM, whether or not with AH

It is necessary to point out that the patients with IM without AH had less risk factors of CVDs; particularly this relates to diabetes mellitus. Higher ejection fraction and better hemodynamic parameters were observed in the patient group without AH as well. It is assumed that presence of diabetes mellitus and decreased ejection fraction are prognostically negative in terms of AMI hazard. The large amount of data in this study is inauthentic, but our research provides approximately the same results as other researches dedicated to this subject. In the future, it is worth to develop the subject for more accurate results, which can be used by practitioners, and to determine the factors influencing on prognosis of disease of these patients.

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