The panic attack is able to mimic the clinical presentation of an acute coronary syndrome (ACS), to the point of being clinically indistinguishable without appropriate investigations. However, the literature actually demonstrates that the 2 conditions are more related than just being differential diagnoses. Through a review of the literature involving epidemiological studies, randomised controlled trials, systematic reviews and meta-analyses found on a Medline search, the relation between panic disorder and ACS is explored in greater depth. Panic disorder, a psychiatric condition with recurrent panic attacks, has been found to be an independent risk factor for subsequent coronary events. This has prognostic bearing and higher mortality rates. Through activation of the sympathetic system by differing upstream mechanisms, the 2 conditions have similar presentations. Another psychiatric differential diagnosis would be that of akathisia, as an adverse effect to antidepressant medications. An overview on the investigations, diagnostic process, treatment modalities and prognoses of the two conditions is presented. Panic disorders remain under-diagnosed, but various interviews are shown to allow physicians without psychiatric training to accurately pick up the condition. Comprehensive multidisciplinary approaches are needed to help patients with both coronary heart disease and anxiety disorder.
Acute Coronary Syndrome ; diagnosis ; physiopathology ; psychology ; Humans ; Panic Disorder ; complications ; diagnosis ; physiopathology ; Risk Factors

Acute Coronary Syndrome ; diagnosis ; Aged ; Diagnosis, Differential ; Echocardiography ; Electrocardiography ; Humans ; Male ; Pneumothorax ; complications ; diagnosis ; Takotsubo Cardiomyopathy ; diagnosis ; etiology

BACKGROUND: Surgical role for acute coronary syndrome has been reduced in recent years due to development of drug eluting stent. We evaluated the surgical results of acute coronary syndrome in our hospital. MATERIAL AND METHOD: Between January 2001 and August 2005, 416 patients underwent coronary artery bypass grafting (CABG) under diagnosis of non-ST-elevation acute coronary syndrome (NSTE ACS). Mean age was 61.8+/-9.0 years and 276 (66.3%) patients were male. 324 (77.9%) patients had triple vessel disease and 92 (22.1%) had left main disease at angiographic study. 236 (56.7%) patients had hypertension and 174 (41.8%) had diabetes mellitus. Conventional on-pump CABG was performed in 194 patients (46.6%) and off-pump CABG in 222 (53.4%). Total arterial revascularization with no touch technique was done in 97 patients (23.3%). The number of total distal anastomosis was 1,306 and the number per patient was 3.21+/-1.71. RESULT: Surgical mortality rate was 1.0% (4 patients) and postoperative complication rate was 15.6% (65 patients). Graft patency was checked at mean 3.7+/-7.6 months (from 1 to 37 months) postoperatively with multi-directional computed tomography in 152 patients. Left internal mammary artery was patent in 95.3%, right internal mammary artery in 98.1%, radial artery in 92.2% and saphenous vein in 89.0%. CONCLUSION: The surgical treatment of NSTE ACS showed relatively low mortality rate and good graft patency rate. Further study is needed to compare the long term results with drug eluting stent.
Acute Coronary Syndrome* ; Coronary Artery Bypass ; Diabetes Mellitus ; Diagnosis ; Humans ; Hypertension ; Male ; Mammary Arteries ; Mortality ; Postoperative Complications ; Radial Artery ; Saphenous Vein ; Stents ; Transplants

The inflammation factors and roles of them in acute coronary syndrome (ACS) were explored. The similarity between the theory of pathogenic toxin in Chinese Medicine and the inflammation response theory in ACS was discussed. The exploration of new inflammatory factors may be helpful for Chinese Medicine in the research of ACS.
Acute Coronary Syndrome ; complications ; diagnosis ; prevention & control ; therapy ; Humans ; Inflammation ; complications ; etiology ; pathology ; therapy ; Inflammation Mediators ; physiology ; Medicine, Chinese Traditional ; Prognosis ; Toxins, Biological ; adverse effects

PURPOSE: Gender-based differences exist in the characteristics, management, and prognosis of acute coronary syndrome (ACS). However, their impact on prognosis remains unclear. We aimed to identify factors causing these differences in Koreans. MATERIALS AND METHODS: We examined 6,636 ACS patients (66.2% males) visiting 72 Korean hospitals between April-2007 and December-2008. Gender-based differences in clinical demographics, therapy, and outcomes were analyzed over 6 months. RESULTS: Women were older than men [mean (standard deviation, SD) age, 67.6 (9.8) vs. 60.6 (11.2) years; p<0.001]; had higher rates of hypertension, diabetes mellitus, and lack of exercise (p<0.001 for all); and lower rates of obesity, familial history of cardiovascular disease (CVD), and smoking (p<0.05 for all). Atypical symptoms were more common in women (20.5% vs. 15.1% in men, p<0.001), whereas myocardial infarction with ST-segment elevation was less common (17.1% vs. 27.8%, p<0.001). Mean (SD) time lapse from symptom onset to arrival at hospital was longer in women [11.44 (18.19) vs. 8.26 (14.89) hours in men, p<0.001], as was the duration of hospitalization [7.58 (7.61) vs. 7.04 (7.72) days, p=0.007]. Fewer women underwent revascularization procedures, including thrombolytic therapy, balloon angioplasty, stent implantation, and coronary artery bypass grafting (79.4% vs. 83.3% men, p<0.001). No significant differences were observed in CVD-related death, recurrent ACS, stroke, refractory angina, or rehospitalization for angina. CONCLUSION: Female ACS patients were older than male subjects and had more atypical presentation. They arrived at the hospital later than men and had longer hospital stays, but less often required revascularization therapy. However, no gender-based differences were noted in ACS-related mortality and morbidity.
Acute Coronary Syndrome/complications/*diagnosis/therapy ; Adult ; Age Factors ; Aged ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Prospective Studies ; Republic of Korea ; Sex Factors

PURPOSE: Cardiac troponin T (cTnT), a useful marker for diagnosing acute myocardial infarction (AMI) in the general population, is significantly higher than the usual cut-off value in many end-stage renal disease (ESRD) patients without clinically apparent evidence of AMI. The aim of this study was to evaluate the clinical usefulness of cTnT in ESRD patients with acute coronary syndrome (ACS). MATERIALS AND METHODS: Two hundred eighty-four ESRD patients with ACS were enrolled between March 2002 and February 2008. These patients were followed until death or June 2009. Medical records were reviewed retrospectively. The cut-off value of cTnT for AMI was evaluated using a receiver operating characteristic (ROC) curve. We calculated Kaplan-Meier survival curves, and potential outcome predictors were determined by Cox proportional hazard analysis. RESULTS: AMIs were diagnosed in 40 patients (14.1%). The area under the curve was 0.98 in the ROC curve (p<0.001; 95% CI, 0.95-1.00). The summation of sensitivity and specificity was highest at the initial cTnT value of 0.35 ng/mL (sensitivity, 0.95; specificity, 0.97). Survival analysis showed a statistically significant difference in all-cause and cardiovascular mortalities for the group with an initial cTnT > or =0.35 ng/mL compared to the other groups. Initial serum cTnT concentration was an independent predictor for mortality. CONCLUSION: Because ESRD patients with an initial cTnT concentration > or =0.35 ng/mL have a poor prognosis, it is suggested that urgent diagnosis and treatment be indicated in dialysis patients with ACS when the initial cTnT levels are > or =0.35 ng/mL.
Acute Coronary Syndrome/blood/complications/*diagnosis/mortality ; Aged ; Biological Markers/blood ; Female ; Humans ; Kidney Failure, Chronic/blood/complications/*diagnosis/mortality ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity ; Troponin T/*blood

PURPOSE: This study was conducted to examine and compare clinical manifestations and predicting factors for treatment-seeking delay among patients <65 and > or =65 yr with first-time acute coronary syndrome (ACS). METHODS: A total of 288 patients who were diagnosed with ACS were individually interviewed at C university hospital in G-city from November 2007 to December 2008. RESULTS: Median pre-hospital delays for younger and older patients were 5 and 12 hr, respectively. Younger patients were more likely to be current smokers, heavy drinkers, obese, stressed, and have an unhealthy diet and family history, and to complain of chest pain, left shoulder and arm pain, perspiration, and nausea. Older patients were more likely to have hypertension and diabetes, and to complain syncope and dyspnea. Logistic regression analyses showed that after adjustment for age, gender and education, progressive onset of symptom and no attribution to cardiac problem significantly predicted pre-hospital delay >3 hr in both younger and older patients. Low perceived health status was a significant independent predictor in older patients only. CONCLUSION: Health care providers should be concerned with different manifestations between younger and older adults, and educate people at risk for heart attack about symptoms and actions to get immediate help.
Acute Coronary Syndrome/complications/diagnosis/*psychology ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Attitude to Health ; Chest Pain/complications ; Diabetes Complications/complications ; Dyspnea/complications ; Female ; *Health Behavior ; Humans ; Hypertension/complications ; Interviews as Topic ; Male ; Middle Aged ; Nausea/complications ; Questionnaires ; Risk Factors ; Syncope/complications ; Time Factors

BACKGROUND/AIMS: The CHADS2 score, used to predict the risk of ischemic stroke in atrial fibrillation (AF) patients, has been reported recently to predict ischemic stroke in patients with coronary heart disease, regardless of the presence of AF. However, little data are available regarding the relationship between the CHADS2 score and cardiovascular outcomes. METHODS: This was a retrospective study on 104 patients admitted for acute coronary syndrome (ACS) who underwent coronary angiography, carotid ultrasound, and transthoracic echocardiography. RESULTS: The mean age of the subjects was 60.1 +/- 12.6 years. The CHADS2 score was as follows: 0 in 46 patients (44.2%), 1 in 31 (29.8%), 2 in 18 (17.3%), and > or = 3 in 9 patients (8.7%). The left atrial volume index (LAVi) showed a positive correlation with the CHADS2 score (20.8 +/- 5.9 for 0; 23.2 +/- 6.7 for 1; 26.6 +/- 10.8 for 2; and 30.3 +/- 8.3 mL/m2 for > or =3; p = 0.001). The average carotid total plaque area was significantly increased with CHADS2 scores > or = 2 (4.97 +/- 7.17 mm2 vs. 15.52 +/- 14.61 mm2; p = 0.002). Eight patients experienced cardiovascular or cerebrovascular (CCV) events during a mean evaluation period of 662 days. A CHADS2 score > or = 3 was related to an increase in the risk of CCV events (hazard ratio, 14.31; 95% confidence interval, 3.53 to 58.06). Furthermore, LAVi and the severity of coronary artery obstructive disease were also associated with an increased risk of CCV events. CONCLUSIONS: The CHADS2 score may be a useful prognostic tool for predicting CCV events in ACS patients with documented coronary artery disease.
Acute Coronary Syndrome/complications/*diagnostic imaging ; Aged ; Carotid Arteries/*diagnostic imaging ; Carotid Artery Diseases/complications/*diagnostic imaging ; Cerebrovascular Disorders/diagnosis/*etiology ; *Coronary Angiography ; Coronary Artery Disease/complications/*diagnostic imaging ; *Decision Support Techniques ; *Echocardiography ; Female ; Humans ; Male ; Middle Aged ; Plaque, Atherosclerotic ; Predictive Value of Tests ; Prognosis ; Republic of Korea ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Time Factors

Acute Disease ; Coronary Aneurysm ; diagnostic imaging ; etiology ; Female ; Humans ; Infant ; Intracranial Hemorrhages ; diagnosis ; diagnostic imaging ; etiology ; Male ; Mucocutaneous Lymph Node Syndrome ; complications ; diagnosis ; diagnostic imaging ; Tomography, X-Ray Computed

OBJECTIVETo investigate the value of serum soluble CD40 ligand (sCD40L) detection in risk evaluation of acute coronary syndromes (ACS).

METHODSThis study involved 200 patients with established diagnosis of ACS, with death or nonfatal myocardial infarction as the end point of observation during the 6-month-long follow-up. Blood samples were obtained from the patients within the initial 72 h of ACS onset, and the levels of sCD40L and C-reactive protein (CRP) were determined with enzyme-linked immunosorbent assay (ELISA). Cardiac troponin I (cTnI) measurement was performed using chemiluminescent immunoassay.

RESULTSOf the 200 patients, 108 had serum sCD40L levels higher than 5.0 microg/L, and the levels of sCD40L, CRP and cTnI were found to significantly correlate with ACS.

CONCLUSIONIndependent detection of serum sCD40L, CRP and cTnI can help predict the risks of ACS, and their combined measurement may increase the sensitivity of the risk prediction and provide new cardiac makers to replace the cardiac enzymes for laboratory diagnosis and risk evaluation of cardiovascular events.

Acute Coronary Syndrome ; blood ; complications ; diagnosis ; Aged ; Biomarkers ; blood ; C-Reactive Protein ; metabolism ; CD40 Ligand ; blood ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; blood ; etiology ; Predictive Value of Tests ; Risk Factors ; Troponin I ; blood