Isolated left ventricular non-compaction (ILVNC) is one of the most misclassified cardiomyopathies. It is caused by failure of normal embryonic development of the myocardium from loosely arranged ...muscle fibers to the mature compacted form of myocardium, but it seems that etiology is not exclusively congenital. Diagnosis of ILVNC is mostly missed because of lack of awareness and knowledge. The recognition of the disease is mandatory, because of its high mortality and morbidity due to the progressive heart failure, thromboembolic events and lethal arrhythmias. We report of a family in which two adult members were found to have ILVNC. A literature review about ILVNC pathogenesis, diagnosing, and treatment was discussed.
There are conflicting data about gender differences in short-term mortality after acute myocardial infarction (AMI) after adjusting for age and other prognostic factors. Therefore, we investigated ...the risk profile, clinical presentation, in-hospital mortality and mechanisms of death in women and men after the first AMI.
The data were obtained from a chart review of 3382 consecutive patients, 1184 (35%) women (69.7+/-10.9 years) and 2198 (65%) men (63.5+/-11.8 years) with a first AMI. The effect of gender and its interaction with age, risk factors and thrombolytic therapy on overall mortality and mechanisms of death were examined using logistic regression.
Unadjusted in-hospital mortality was higher in women (OR 1.77, 95% CI 1.47-2.15). Adjustment that included both age only and age and other baseline differences (hypertension, diabetes mellitus, hypercholesterolemia, smoking, AMI type, AMI site, mean peak CK value, thrombolytic therapy) decreased the magnitude of the relative risk of women to men but did not eliminate it (OR 1.26, 95% CI 1.03-1.54 and OR 1.31 95% CI 1.03-1.66, respectively). Multivariate analysis revealed that female gender was an independent predictor of in-hospital mortality after the first AMI. Women were dying more often because of mechanical complications - refractory pulmonary edema and cardiogenic shock (P=0.02) or electromechanical dissociation (P=0.03), and men were dying mostly by arrhythmic death, primary ventricular tachycardia/fibrillation (P=0.002). Female gender was independently associated with mechanical death (OR 1.56, 95% CI 1.35-2.58; P=0.01) and anterior AMI was independently associated with arrhythmic death (OR 0.54, 95% CI 0.34-0.86; P=0.01).
Our results demonstrate significant differences in mechanisms of in-hospital death after the first AMI in women and men, suggesting the possibility that higher in-hospital mortality in women exists primarily because of the postponing AMI death due to the gender-related differences in susceptibility to cardiac arrhythmias following acute coronary events.
The importance of pathophysiological mechanisms involved in onset of acute myocardial infarction (AMI) differs with age, gender, and risk profiles. Diversity in the triggering of cardiovascular ...events has been observed, particularly between men and women. Therefore, we investigated the relationship between age, gender, and risk factors and location of AMI and the presence of Q waves in ECG.
Data was obtained from a chart review of 2958 patients with first AMI: 770 (26%) patients with non-Q-wave AMI and 2188 (74%) patients with Q-wave AMI. Four clinical groups were formed by predetermined criteria (anterior Q-wave, anterior non-Q-wave, inferior Q-wave, inferior non-Q-wave). A logistic regression was performed to assess independent predictors of AMI type and site.
Key findings were: 1) inferior non-Q-wave AMI was more frequent in young women (P<0.001); 2) inferior Q-wave AMI was more common in young men (P<0.001); 3) anterior non-Q-wave AMI was more common in older men (P<0.001). Multivariate analysis revealed that independent predictors of anterior non-Q-wave AMI were age over 65 (P=0.002), male gender (P=0.04) and hypercholesterolemia (P=0.0003), and that predictors of inferior Q-wave AMI were male gender (P<0.0001), smoking (P=0.04) and diabetes (P=0.049). In the gender-subgroup analyses, age <45 years (P=0.04), hypecholesterolemia (P=0.02) and smoking (P=0.01) were independent predictors of inferior Q-wave AMI whereas age >65 years (P<0.0001) and smoking (P=0.0003) were predictors of anterior non-Q-wave AMI in men. In women, age <45 years (P<0.0001) and smoking (P=0.02) were independent predictors of non-Q-wave AMI and hypercholesterolemia (P=0.02) was a predictor of inferior Q-wave AMI.
The link between particular types and the site of AMI and age, gender and risk factors suggest that the importance of pathophysiological mechanisms for onset of AMI differs according to sex and age subgroup.
Objective: We examined the association of dermatological signs such as baldness, thoracic hairiness, hair greying and diagonal earlobe crease with the risk of myocardial infarction in men under the ...age of 60 years.
Methods: A hospital-based, case-control study included 842 men admitted for the first non-fatal myocardial infarction, the controls were 712 men admitted with noncardiac diagnoses, without clinical signs of coronary disease. The relative risks were estimated as odds ratios. Logistic regression was used to control for the confounding variables.
Results: Baldness, thoracic hairiness and earlobe crease were ∼40% more prevalent in cases (
P<10
−6 in each case). In both cases and controls, baldness and thoracic hairiness were frequently coexistent, as well as hair greying and earlobe crease (
P<10
−4 in each case). After allowing for age and other established coronary risk factors, the relative risk of myocardial infarction for fronto-parietal baldness compared with no hair loss was 1.77 (95% CI 1.27–2.45) and it was 1.83 (95 CI 1.4–2.3) for men with thick, extended thoracic hairiness. The presence of a diagonal earlobe crease yielded a relative risk of 1.37 (95% CI 1.25–1.5), while hair greying was associated with myocardial infarction only in men under the age of 50 years.
Conclusion: It appears that baldness, thoracic hairiness and diagonal earlobe crease indicate an additional risk of myocardial infarction in men under the age of 60 years, independently of age and other established coronary risk factors.
Popliteal artery entrapment syndrome is an important albeit infrequent cause of serious disability among young adults and athletes with anomalous anatomic relationships between the popliteal artery ...and surrounding musculotendinous structures. We report our experience with 3 patients, in whom we used duplex ultrasonography, computed tomography, digital subtraction angiography, and conventional arteriography to diagnose popliteal artery entrapment and to grade the severity of dynamic circulatory insufficiency and arterial damage. We used a posterior surgical approach to give the best view of the anatomic structures compressing the popliteal artery. In 2 patients, in whom compression had not yet damaged the arterial wall, operative decompression of the artery by resection of the aberrant muscle was sufficient. In the 3rd patient, operative reconstruction of an occluded segment with autologous vein graft was necessary, in addition to decompression of the vessel and resection of aberrant muscle. The result in each case was complete recovery, with absence of symptoms and with patency verified by Doppler examination. We conclude that clinicians who encounter young patients with progressive lowerlimb arterial insufficiency should be aware of the possibility of popliteal artery entrapment. Early diagnosis through a combined approach (careful physical examination and history-taking, duplex ultrasonography, computerized tomography, and angiography) is necessary for exact diagnosis. The treatment of choice is the surgical creation of normal anatomy within the popliteal fossa.
The aim of this study was to determine the pattern of myocardial infarction (MI) incidence with regard to age, gender, infarction site, and the most important risk factors. All 3,454 patients ...hospitalized in coronary care units of Clinical Hospital Split between 1989 and 1997 were analyzed. In the 3-year period preceding the war, from 1989 to 1991, 1,024 patients were hospitalized because of MI. During the 3 years of full war activities, from 1992 to 1994, there were 1,257 patients (significantly more; p < 0.05). And in the 3-year period after the war, from 1995 to 1997, there were 1,173 patients. In the war period, there were 151 (12%) patients younger than 45 years of age (p < 0.05); of that number, 143 (95%) were men (significantly more than in the other two periods; p < 0.05) and 8 (5%) were women. In the period preceding the war, there were 66 (6.5%) patients younger than 45 years: 60 (91%) men and 6 (9%) women. In the period after the war, those numbers were 88 (7.5%), 81 (92%), and 7 (8%), respectively. The patients younger than 45 years (305) more often had MI of an inferior than an anterior site (49% vs. 28%; p < 0.001), whereas there was no difference in patients older than 45 years (36% vs. 37%; p > 0.05). The patients older than 45 years had significantly greater hospital mortality (21% vs. 4%; p < 0.001) and were more likely to have hypertension (51% vs. 15%; p < 0.001) as well as hypercholesterolemia (54% vs. 14%; p < 0.001). Smokers prevailed among those younger than 45 years (75% vs. 51%; p < 0.001). The number of hospitalized patients with MI was greatest during the war period. It included a significant increase in the incidence in men younger than 45 years (12% vs. 7%; p < 0.05), with smoking as the most important risk factor, especially for infarctions of inferior sites.
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