Clinical Analysis of Acute Myocardial Infarction in Elderly Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WANG Hongjun , YU Hongtao , JIA Jinguang

Department of Respiratory Medicine, People’s Hospital of Zhengzhou. Zhengzhou, He’nan, 450000, ChinaCorresponding Author: WANG Hong-jun, E-mail: whjun1919@ 163. com;

Corresponding author：

Keywords：

Chronic obstructive pulmonary disease; Myocardial infarction; Infection; Respiratory failure

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Objective To investigate the clinical characteristics of acute myocardial infarction ( AMI) in elderly patients with acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) .Methods Clinical data of 16 elderly patients with AECOPD and AMI from may 2007 to December 2009 were reviewed. Meanwhile, 128 elderly AECOPD patients without AMI were analyzed as control. Results Neither the AMI group nor the control group had typical precordial pain, conscious disturbance, and
hypotension. Compared with the control group, the main symptoms of the AMI group were worsening of chest tightness and dyspnea( 16 /16 vs. 4/128, P lt;0. 01) ,most of which accompanying fever( 11/16 vs. 6/128, P lt;0. 05) and anorexia ( 10/16 vs. 23 /128, P lt; 0. 05) . The incidence of patches-like shadow on chest X-ray
increased ( 16 /16 vs. 62/128, P lt;0. 05) , PaO2 ( mm Hg) decreased ( 43. 72 ±3. 64 vs. 82. 26 ±11. 41, P lt;0. 001) , the red blood cell count ( ×1012 /L) increased ( 6. 43 ±0. 42 vs. 4. 11 ±1. 24, P lt; 0. 05) , the concentration of total cholesterol ( mmol /L) increased ( 6. 51 ±0. 84 vs. 3. 93 ±1. 14, P lt; 0. 05) , the need
for invasive mechanical ventilation increased ( 13/16 vs. 11 /128, P lt; 0. 05) , the days in hospital were prolonged ( 35 ±13 vs. 11 ±3, P lt; 0. 01) , the cost ( 1000 RMB) increased( 32 ±11 vs. 7. 6 ±2. 8, P lt;0. 01) , and the mortality also increased ( 2/16 vs. 3 /128, P lt;0. 01) . Conclusion AMI should be alerted in the case of sudden exacerbation of chest tightness and dyspnea in elderly patients with AECOPD.

Citation： WANG Hongjun,YU Hongtao,JIA Jinguang. Clinical Analysis of Acute Myocardial Infarction in Elderly Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Chinese Journal of Respiratory and Critical Care Medicine, 2010, 9(6): 627-630. doi: Copy

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5.	Selcuk H, Maden O, Selcuk MT, et al. Documentation of impaired coronary blood flow in chronic obstructive pulmonary disease patients. Circ J, 2010 , 74: 346-352.
6.	Clayton TC, Thompson M, Meade TW. Recent respiratory infection and risk of cardiovascular disease: case-control study through a general practice database. Eur Heart J, 2008 , 29 : 96-103 .
7.	Madjid M, Vela D, Khalili-Tabrizi H, et al. Systimic infections cause exaggerated local inflammation in atherosclerotic coronary arteries:clues to the triggering effect of acute infection on acute coronary syndromes. Tex Heart Inst J, 2007, 34: 11-18.
8.	McNicol A, Israsels SJ. Beyond hemostasis: the role of platelets in inflammation malignancy and infection. Cardiovasc Hematol Disord Drug Targets, 2008, 8: 99-117.
9.	Stone PH. Triggering myocardial infarction. N Engl J Med, 2004 ,351: 1716-1718.
10.	Schouten M, Wiersinga WJ, Levi M, et al. Inflammation,endothelium, and coagulation in sepsis. J Leukoc Biol, 2008, 83 :536-545.
11.	Tekin M, G??kaslan S, Diker E, et al. Development of acute coronary syndrome in three patients with essential thrombocythemia or polycythemia vera. Turk Kardiyol Dern Ars, 2008, 36: 35-38 .
12.	陈国荣. 局部血液循环障碍. 见: 病理学. 李玉林, 主编. 第7 版.北京: 人民卫生出版社, 2008, 38 -57 .
13.	何权瀛, 周新, 谢灿茂, 等. 慢性阻塞性肺疾病对中国部分城市患者生命质量和经济负担的影响. 中华结核和呼吸杂志, 2009 ,32: 253-257 .

1. Zhong N,Wang C, Yao W, et al. Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey. Am J Respir Crit Care Med, 2007 , 176: 753-760 .
2. Finkelstein J, Cha E, Scharf SM. Chronic obstructive pulmonary disease as an independent risk factor for cardiovascular morbidity.Int J Chron Obstruct Pulmon Dis, 2009, 4: 337 -349.
3. 中华医学会心血管病学分会, 中华心血管病杂志编辑委员会.不稳定性心绞痛和非ST 段抬高心肌梗死诊断和治疗指南. 中华心血管病杂志, 2007, 35: 295 -304.
4. Sabit R, Bolton CE, Edwards PH, et al. Arterial stiffness and osteoporosis in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2007, 175: 1259-1265.
5. Selcuk H, Maden O, Selcuk MT, et al. Documentation of impaired coronary blood flow in chronic obstructive pulmonary disease patients. Circ J, 2010 , 74: 346-352.
6. Clayton TC, Thompson M, Meade TW. Recent respiratory infection and risk of cardiovascular disease: case-control study through a general practice database. Eur Heart J, 2008 , 29 : 96-103 .
7. Madjid M, Vela D, Khalili-Tabrizi H, et al. Systimic infections cause exaggerated local inflammation in atherosclerotic coronary arteries:clues to the triggering effect of acute infection on acute coronary syndromes. Tex Heart Inst J, 2007, 34: 11-18.
8. McNicol A, Israsels SJ. Beyond hemostasis: the role of platelets in inflammation malignancy and infection. Cardiovasc Hematol Disord Drug Targets, 2008, 8: 99-117.
9. Stone PH. Triggering myocardial infarction. N Engl J Med, 2004 ,351: 1716-1718.
10. Schouten M, Wiersinga WJ, Levi M, et al. Inflammation,endothelium, and coagulation in sepsis. J Leukoc Biol, 2008, 83 :536-545.
11. Tekin M, G??kaslan S, Diker E, et al. Development of acute coronary syndrome in three patients with essential thrombocythemia or polycythemia vera. Turk Kardiyol Dern Ars, 2008, 36: 35-38 .
12. 陈国荣. 局部血液循环障碍. 见: 病理学. 李玉林, 主编. 第7 版.北京: 人民卫生出版社, 2008, 38 -57 .
13. 何权瀛, 周新, 谢灿茂, 等. 慢性阻塞性肺疾病对中国部分城市患者生命质量和经济负担的影响. 中华结核和呼吸杂志, 2009 ,32: 253-257 .

Chinese Journal of Respiratory and Critical Care Medicine

Clinical Analysis of Acute Myocardial Infarction in Elderly Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

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