INTRODUCTION: Coronary Artery Disease (CAD) in young Indians, which accounts for 12-16% of cases in people below 45 years old and contributes to 50% of CAD-related deaths in those below 50 years. Traditional risk factors for CAD as hypertension and smoking explain most cases of CAD, but 15-20% have no identifiable risk factors. Recent studies show elevated Lp(a) and hyperhomocysteinemia play a role in MI and that measuring Apo B and Apo A1 is better than measuring LDL-C and HDL-C. The true prevalence of CAD in the young is understated and this study aims to determine the association of newly identified and traditional risk factors with premature onset of CAD in those 40 years or younger.Method: This was a prospective, observational study conducted in the department of general medicine at Jhalawar Medical College on 50 patients who had suffered an acute myocardial infarction.A comprehensive evaluation was performed using a pre-test proforma that included a detailed clinical history, physical examination, electrocardiography, biochemical analysis, and an echocardiographic evaluation.Results: The majority of patients (60%) were in the age range of 35-40 years,with the youngest being 19 years old.88% of the patients were male and the mean age for female patients was 36.17 years and for males, it was 34.02 years.The most common symptom in young patients was chest pain (90%),followed by sweating (52%) and breathlessness (30%).The most common risk factor for MI was tobacco abuse (86%), followed by a positive family history of CAD (16%) and a high BMI (8%).The majority of patients (72%) had multiple risk factors for AMI,24% had a single risk factor,and 4% had none.The homocysteine level was above normal in 42% of patients, with 2% having a high risk. Conclusion: Our study highlights the importance of addressing risk factors for better patient outcomes in the case of Acute Myocardial Infarction (AMI).To address the high prevalence of cigarette smoking in young adults,preventive educational programs and smoking cessation clinics need to be established.Medical personnel should prioritize educating the youth on diabetes and cholesterol management

INTRODUCTION:Acute chest pain is one of the most common reasons for seeking care in the emergency department (ED), accounting for approximately 10% of all visits. The difficulty lies in discriminating patients with ACS or other lifethreatening conditions from those with non-cardiovascular,non-life-threatening chest pain.The diagnosis ofACS is missed in approximately 2%ofpatients.But itis essential to rule out cardiovascular etiology of chestpain to avoidunnecessary cost and complications of investigations and treatment. This study aims at identifying the prevalence of significant coronary artery disease in patients with no electrocardiographic and biochemical evidence of coronary artery disease. AIM OF STUDY: To identifying the presence of severe coronary artery disease in the patients with no electrocardiographic, biochemical and echocardiographic evidence of CAD using CT Coronary Angiography. MATERIAL AND METHODS: The study was conducted on 50 patients during a period of 4 months,admitted with history of chest pain without any ECG evidence of STEMI, negative cardiac markers, no evidence of RWMA on 2D ECHO, or previous history of myocardial infarction.RESULTS: Out of the 50 patients studied, 38 (76%) were males and 12 (24%) were females.A total of 6 patients (12%) were found to have severe stenosis in major coronary arteries (stenosis > 70%) of which 4 were males (10.5%) and 2 were females (16.67%).CADRAD score≥3 was found in 9 patients (18%):6 males (15.78%) and 3 females (12%).Average age of patients who presented with chest pain with no electrocardiographic and biochemical evidence of coronary artery disease was found to be 61.7 years in males and 60.1 in females.66.7% of the female patients and 78.94% of male patients were over the age of 55 years.CONCLUSION: Furtherworkupofpatientswith chestpainwith no electrocardiographic and biochemicalevidenceofcoronaryarterydiseaseisnecessarytoavoidmissingdiagnosisofCAD

No abstract

INRODUCTION: Chronic obstructive pulmonary disease (COPD) and heart failure are two major causes of mortality, globally. Coexistence of both conditions cause diagnostic difficulties because of similarities in symptoms and signs. Most patients with both conditions are characterized by high mortality.Age,sex and comorbidities are considered to be the major predictors of mortality in patients with COPD and heart failure alone.Undiagnosed heart failure in patients of COPD has catastrophic consequences.AIM OF STUDY:To describe prevalence of heart failure in COPD patients and its impact on in hospital mortality.MATERIAL AND METHODS:An observational study was conducted on 100 diagnosed cases of COPD for a period of 6 months,admitted in medicine ward and medical intensive care unit at Jhalawar Medical College.RESULTS: Out of the 100 patients studied,72 (72%) were males and 28 (28%) were females.23 patients (23%) were diagnosed with coexisting heart failure. In hospital mortality was 12%, mortality among coexisting heart failure patients was higher (30.43%) in comparison to patients with only COPD (6.49%)- odd ratio 6.3 (95% CI 1.77-22.41). CONCLUSION: Heart failure has an important impact on in hospital mortality in patients with COPD. Heart failure and other comorbidities should be recognized early and properly treated in order to improve survival in patients with COPD