Etiology And Clinical Characteristics Of Young Patients With Acute Chest Pain

Objective: Acute chest pain is the foremost initial symptom of sudden cardiac death in young patients. The proportion of young patients who suffered from acute chest pain has been on the rise over the past years.To strengthen the understanding of young patients with acute chest pain, we explored the clinical characteristics, risk factors, etiology and pathogenesis of young patients with acute chest patient,which may reduce the morbidity of sudden cardiac death in young people.Methods:This study included 3 parts:1、220 young patients under age 14-44 admitted from June to December 2004 in PLA general hospital were treated with selective coronary angiography suffering from acute chest pain, whose general information, levels of blood biochemical index and echocardiography resultswere retrospectively analyzed. We compared the differences between positive group and negative group basing on coronary angiography results.2、134 young patients with acute chest pain admitted in PLA general hospital from January to December 2014 were suspected ACS and performed check of selective coronary angiography.77 cases of healthy people were control group. We explored the causes of negative group.3、A computer-assisted search was performed using prominent electronic medical information sources including CBMDISC, PUBMED, EMBASE, SCI and Cochrane to identify literature published between January 1965 and December 2013. Relevant studies containing clinical data of young Takotsubo cardiomyopathy patients were included. We collected the clinical data of these patients and made a systematic review.4、Stata 7.0 was used to perform allstatistical evaluations. Quantitativevariables were presented asmeans±tandard deviations and compared using t-test or Wilcoxon-rank sun test, categoricaldata are presented as absolutevalues and percentages and compared using Chi-square test, then we conducted logistic regression analysis. Any P<0.05 was considered statisticallysignificant.Results:1、The young patients with CHD had higher mobidity in male(P=0.0025), with smoking history(P=0.0365)and hypertension history(P=0.0035), higher levels of cTnT (P=0.000), BNP(P=0.000), TC(P=0.0232), LDL-C(P=0.0409), glucose (P =0.000), Fib(P=0.035),TBIL(P-0.001) andDBIL(P=0.0048) compared with the patients in negative group (P<0.05). It was still known statistically significant in lower levels of LVEF (P=0.000), FS(P=0.000) and higher left ventricular end systolic volume (P=0.006) in positive group compared with negative group. The results of coronary angiography were significantly associated with gender (OR=3.4), smoking history (OR=2.4), hypertension history (OR=1.98), levels of TC (OR=1.34),LDL-C (OR=1.38), Fib (OR=1.77), TBIL (OR=0.91) and DBIL (OR=0.77).2、The causes of negative group were made up with coronary atherosclerosis (90.6%), cardiac neurosis (4.7%), cardiomyopathy (1.6%), cardiac syndrome X (1.6%), and other (3.2%). There were 81.1% male and 58.9% civil service management and business service personnel in negative group. The young patients in negative group had higher levels of BMI (P=0.000), HBAlc (P=0.001), TG (P=0.000), CRP (P =0.003), cTnT (P=0.009) and lower HDL-C(P=0.000) compared with the patients in healthy group which was considered statisticallysignificant.The level of BNP (P =0.128) in the two groups had no significant difference.3、Ninety-six records that included information about 104 cases were ultimately selected for our review. Several of the following results were noted:First, physical stress was more likely to exacerbate TTC than was mental stress in young patients. Second, more female than male TTC patients were noted among both young patients and the general population. Third, ethnicity appears to play no role in the disease, asno significant differences were noted among individuals of different races with respect to clinical characteristics, morbidity or stressors. Fourth, the clinical manifestations of TTC were similar to those of other cardiac diseases,including coronary heart disease. However, TTC may be detected using the combination of echocardiography and ventriculography.Conclusion:1、Male, hypertension history, smoking history, higher levels of TC, LDL-C and Fib, lower levels of TBIL and DBIL are the major risk factors of acute coronary syndrome in young people. Early diagnosis and prevention are important in these specific patients, which may reduce the happen of sudden cardiac death;2、Coronary atherosclerosis is the major cause of young patients with acute chest pain suspected acute coronary syndrome(ACS) and with negative coronary angiography results. Male, high tension occupation, obesity, pathoglycemia and dyslipidemia are risk factors. Early diagnosis and prevention are import in the specific group;3、Clinicians should consider TTC if young patients present with symptoms similar to those of acute coronary syndrome so that harmful treatments such as coronary artery stent placement may be avoided and the incidence of sudden cardiac death can be reduced. Moreover, the answers to questions regarding the clinical diagnostic criteria, etiology, pathophysiology, and the management of this syndrome in youth remain unclear; therefore, further research is needed.