Background and Objectives: In patients admitted to the Intensive Care Unit (ICU) for non cardiac disease, the diagnosis of acute coronary syndromes can be challenging. The aim of the study was to study the clinical profile of patients developing myocardial injury in critically ill elderly patients admitted to ICU for non-cardiac diagnosis and clinical profile with outcome at discharge from ICU. .

Materials and Methods: The retrospective study subjects are 130 patients admitted to medical ICU. A detailed  history, a 12 lead ECG, Cardiac troponin T,CK-MB will be done within 24 hours of admission to ICU and as required based on ECG findings and development of clinical symptoms.

Results: The study revealed that 35 out of 130 patients developed acute myocardial injury. 13 out of 35 patients who had myocardial injury had fatal outcome. The prevalence of diabetes mellitus, hypertension, past history of IHD, past history of CVA and COPD reached statistical significance (p<0.001) between the two groups of patients who developed myocardial injury and who did not develop myocardial injury. In patients with multiple comorbidities, the presence of following trigger factors increases the risk of mortality. These trigger factors are 1) hypotension with use of vasopressor agents  2) anemia  3) hypoxia and 4) hypoglycemia or hyperglycemia, 5)poorly supplemented hypothyroidism.

Conclusion: All elderly patients with or without multiple comorbidities who are hospitalised with acute form of stressors must be aggressively evaluated for precipitants and adequately treated to prevent myocardial injury.

1. Kadaklouche et al, The Diagnostic Challenge of Myocardial Infarction in Critically Ill Patients: Do High-sensitivity Troponin Measurements Add More Clarity or More Confusion? Critical Care 2014 18:148.
2. Ian webb and jamescoutts, Myocardial Infarction on the ICU: can we do better? Critical Ccare 2008,12:129.
3. Priyanka G, Myocardial injury in critically ill elderly patients with non-cardiac diagnosis at admission,2016.
4. Berlot G, Vergolini A, Calderan C, Bussani R, Torelli L, Lucangelo U. Acute myocardial infarction in non-cardiac critically ill patients: a clinical-pathological study. Monaldi Archives for Chest Disease. 2010;74(4).
5. Wendy Lim et al, Elevated Cardiac Troponin Levels in Critically Ill Patients: Prevalence, Incidence, and Outcomes. American Journal of Critical Care, May 2006, Volume 15, No. 3.
6. Venkatesh, et al.: Atypical Manifestations of Diseases in Elderly Patients in Critical Care Areas. International Journal of Scientific Study | October 2015 | Vol 3 | Issue 7
7. Ostermann et al.: A prospective study of the impact of serial troponin measurements on the diagnosis of myocardial infarction and hospital and six-month mortality in patients admitted to ICU with non-cardiac diagnoses. Critical Care 2014 18:R62.
8. Cardiac Troponin T Trials Group., Elevated troponin and myocardial infarction in the intensive care unit: a prospective study. Critical Care 2005, 9:R636-R644.
9. Michael liu et al., Prognostic value of initial elevation of cardiac troponin I level in critically ill patients without acute coronary syndrome. Critical Care Nurse 2015 Vol 35, No. 2.
10. Fabio et al. Anemia and Ischemia: Myocardial Injury in Elderly with Gastrointestinal Bleeding. American journal of Medicine 2005.118, 548-551.
11. Subramanian et al., Hypoglycemia and Myocardial Infarction: Inhibition of Ischemic Preconditioning Response. Indian journal of Endocrinology on Metabolism 2012 may-june, 16(3):473-474.
12. Mahmut et al., The value of Admission Glycosylated Hemoglobin Level in patients with Acute Myocardial Infarction. Canadian Journal of Cardiology 2008 vol 24 no 5.
13. Wali M et al., Prognostic Importance of Hyponatremia in ST Elevation Myocardial Infarction. American Journal of Medicine 2004, 117, 242-248.

Dr Y. Dharanidhar Reddy

Post Graduate, S.S. Institute of Medical Sciences and Research Centre, Davangere, Karnataka, India