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Clinical Medicine

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Browsing Clinical Medicine by Subject "Acute myocardial infarction."

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    The effect of lifestyle modification on depression amongst myocardial infarction patients after revascularization.
    (2020) Arzet, Aminu.; Naidoo, Datshana Prakesh.
    Background: Patients with Coronary Artery Disease (CAD) are prone to depression, and its presence is associated with poor adverse cardiac outcomes. Although lifestyle modification (LSM) has been shown to be beneficial in managing depression in patients with CAD, it is not known whether the mode of cardiac intervention (coronary artery bypass graft surgery {CABG} vs percutaneous coronary intervention {PCI}) influences the outcome Objectives: We examined the prevalence of depression and depression traits amongst myocardial infarction (MI) patients after revascularisation and compared the effect of LSM on incidence of depression and depression traits in patients who underwent CABG versus PCI Method: We evaluated the risk factor profile, depression characteristics and lifestyle changes of 100 consecutive participants undergoing coronary revascularization over a 15-month period (Jan 2017 to March 2018). The Beck Depression Inventory II (BDI-II) was used to assess depression and the Goldin leisure-time exercise (GLTE) questionnaire to assess physical activity (PA). Results: 100 patients were recruited (mean age males 60.73±4.52 yr and females 60.29±3.64 yr), with 5 dropouts leaving 95 patients for complete analysis. Most of the patients were low-income earners 53 (53.0%) and 21.0% had tertiary level education. The majority had multiple CAD risk factors and comorbidities (79.0%). Prior to the LSM program 51 patients (51.0%) had depression and depression traits {CABG 34 (66.7%) vs PCI 17 (33.3%), p = 0.047)}. After LSM the overall prevalence of depression and depression traits fell to 33 patients (34.7%), {PCI 8 (23.0%) vs CABG 25 patients (72.0%), p = 0.001}. The mean depression scores also fell from 21.11±7.75 to 14.98±9.61 (p = 0.002). At baseline PCI patients were more physically active compared to CABG {3 (60.0%) vs 2 patients (40.0%), P = 0.715} respectively. After the LSM, more PCI patients undertook PA compared to CABG {24 (60.0%) vs 14 patients (35.0%) respectively, p = 0.012}. The PA score was also higher amongst the PCI group compared to CABG {14.16±9.73 vs 9.40±10.94 respectively, p = 0.024}. In fully compliant subjects the benefit derived was similar regardless of the mode of intervention {OR 1.10, CI 0.98-4.23,P = 0.191}. Using multivariate analysis the main predictors of depression and depression traits were female gender (OR 3.29, 95% CI 1.51-11.03, p = 0.008), CABG (OR 1.86, 95% CI 1.68-5.77, p = 0.003), heart failure (OR 2.65, 95% CI 5.87-13.62, p = 0.000), Kidney failure (OR 1.41, 95% CI 1.30-5.23, P = 0.041), atrial fibrillation (OR 1.60, 95% CI 1.40-4.77, P = 0.023), low PA (OR 1.97, 95%, CI 11.23- 33.20, P = 0.000), previous history of depression (OR 8.99,95% CI 1.90-7.89, p = 0.002) and low income (OR 2.21, 95% CI 1.40-2.85, p = 0.000). Conclusions: Depression and depression traits are common among subjects undergoing coronary revascularization, more so amongst CABG compared to PCI participants. Lifestyle modification reduces the prevalence of depression and depression traits, with fully compliant CABG vs PCI groups deriving nearly the same benefits from the LSM regime. No significant reduction in depression and depression was recorded amongst LSM partlycompliant patients. This study suggests that failure to implement lifestyle changes and engage in PA are major barriers to managing depression after coronary revascularisation.
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    Risk factor profile of female patients presenting with acute myocardial infarction: a South African perspective.
    (2017) Govender, Jaqueline Cindy.; Ranjith, Naresh.
    The study was a retrospective single center study conducted at RK Khan hospital in Durban. The primary aim was to look at the incidence of acute myocardial infarction (AMI) in the female population in our setting with particular interest in the cardiovascular risk profile of female patients presenting with AMI. Data was extracted from a computerized database for the duration of the study period, which was from 2003 to 2016. Patient anonymity was maintained. All adult female patients that presented to the study center during the study period, with a diagnosis of AMI, based on the European and American Society of Cardiology guidelines, were included in the study. Females with unstable angina were excluded. The cardiovascular disease (CVD) risk factor profile was based on the Framingham risk profile for CVD and included the following: diabetes mellitus (DM), hypertension (HPT), cigarette smoking, dyslipidemia, obesity, a previous history of coronary artery disease and positive family histories of DM, HPT and coronary artery disease. The study population was broadly categorized into 2 age groups, namely <65 years of age and >65 years. Both groups were analyzed identically in terms of their age, clinical presentation, CVD risk factors, initial electrocardiogram, medical therapies and whether or not they were referred for an angiogram and/or coronary artery bypass surgery. We also divided the study population into those with ST elevation myocardial infarction (STEMI) versus Non ST elevation myocardial infarction. In the STEMI group we assessed the use of thrombolytic therapy or not. Finally we looked at the presence of major adverse cardiac events (MACE) in each of the age groups. MACE was defined as follows: Arrhythmias, cardiac failure, cardiogenic shock, complete heart block, recurrence of angina or myocardial infarction and death. In addition to the primary study aim, by categorizing patients into 2 age groups we could determine if there was a difference in CVD risk factor profile and the presence of MACE between the younger and older age groups. Finally, by comparing the outcome of our study to studies done in male counterparts we were able to see if there was a difference in CVD risk profile between male and female patients, which in fact there was not. So basically in the presence of the traditional risk factors for coronary artery disease (CAD), males and females can be considered at equal risk of developing acute myocardial infarction and females are not protected by the cardioprotective effects of oestrogen hormone in the pre-menopausal age group as was previously thought. Females are an understudied population when it comes to coronary artery disease and very few studies have been conducted on females with cardiac disease. We believe that this study offers some very valuable information with regards to cardiac disease in females and that treatment strategies should be targeted to include optimizing risk factor control in at-risk females, so that the burden of disease can be reduced in this population.