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Cardiologia Croatica, Vol. 17 No. 9-10, 2022.

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https://doi.org/10.15836/ccar2022.288

Cardiac emergencies in the emergency department after the 2020 earthquake – Croatian experiences

Zdravko Babić orcid id orcid.org/0000-0002-7060-8375 ; Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia
Marin Pavlov orcid id orcid.org/0000-0003-3962-2774 ; Dubrava University Hospital, Zagreb, Croatia
Petra Radić orcid id orcid.org/0000-0002-4842-7156 ; Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia
Jozica Šikić orcid id orcid.org/0000-0003-4488-0559 ; University of Zagreb, School of Medicine, Zagreb, Croatia
Edvard Galić orcid id orcid.org/0000-0002-5707-0961 ; University of Zagreb, School of Medicine, Zagreb, Croatia
Tomislav Letilović orcid id orcid.org/0000-0003-1229-7983 ; University of Zagreb, School of Medicine, Zagreb, Croatia
Diana Balenović orcid id orcid.org/0000-0001-8182-6848 ; Sisak General Hospital, Sisak, Croatia
Davor Horvat orcid id orcid.org/0000-0003-2360-5793 ; Karlovac General Hospital, Karlovac, Croatia
Luka Perčin orcid id orcid.org/0000-0003-0497-6871 ; University Hospital Centre Zagreb, Zagreb, Croatia
Dubravka Šipuš orcid id orcid.org/0000-0002-5631-0353 ; University Hospital Centre Zagreb, Zagreb, Croatia
Valentina Obadić orcid id orcid.org/0000-0001-9915-5122 ; “Merkur” University Hospital, Zagreb, Croatia
Davor Miličić orcid id orcid.org/0000-0001-9101-1570 ; University of Zagreb, School of Medicine, Zagreb, Croatia

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Abstract

Keywords

earthquake; cardiac emergencies; emergency department

Hrčak ID:

289797

URI

https://hrcak.srce.hr/289797

Publication date:

8.12.2022.

Visits: 539 *

Copyright: 2022, Croatian Cardiac Society

Date received: 04 November 2022

Date accepted: 10 November 2022

Publication date (print and electronic): November 2022

Volume: 17

Issue: 9-10

Pages: 288-289

Publisher ID: CC 2022 17_9-10_288-9

DOI: 10.15836/ccar2022.288

Article Information (continued)

Categories:

Subject: Extended Abstract

Categories:

Subject: Acute and intensive cardiology

KEYWORDS: :

KEYWORDS:

Keyword: earthquake

Keyword: cardiac emergencies

Keyword: emergency department

Cardiac emergencies in the emergency department after the 2020 earthquake – Croatian experiences

[https://orcid.org/0000-0002-7060-8375] Zdravko Babić[1][2]

[https://orcid.org/0000-0003-3962-2774] Marin Pavlov[3]

[https://orcid.org/0000-0002-4842-7156] Petra Radić[1][*]

[https://orcid.org/0000-0003-4488-0559] Jozica Šikić[2][4]

[https://orcid.org/0000-0002-5707-0961] Edvard Galić[2][4]

[https://orcid.org/0000-0003-1229-7983] Tomislav Letilović[2][5]

[https://orcid.org/0000-0001-8182-6848] Diana Balenović[6]

[https://orcid.org/0000-0003-2360-5793] Davor Horvat[7]

[https://orcid.org/0000-0003-0497-6871] Luka Perčin[8]

[https://orcid.org/0000-0002-5631-0353] Dubravka Šipuš[8]

[https://orcid.org/0000-0001-9915-5122] Valentina Obadić[5]

[https://orcid.org/0000-0001-9101-1570] Davor Miličić[2][8]

 

[1] Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia

[2] University of Zagreb, School of Medicine, Zagreb, Croatia

[3] Dubrava University Hospital, Zagreb, Croatia

[4] “Sveti Duh” University Hospital, Zagreb, Croatia

[5] “Merkur” University Hospital, Zagreb, Croatia

[6] Sisak General Hospital, Sisak, Croatia

[7] Karlovac General Hospital, Karlovac, Croatia

[8] University Hospital Centre Zagreb, Zagreb, Croatia

Author notes:

Correspondence to: [*] ADDRESS FOR CORRESPONDENCE: Petra Radić, Klinički bolnički centar Sestre milosrdnice, Vinogradska cesta 29, HR-10000 Zagreb, Croatia. / Phone: +385-99-4699-642 / E-mail: petra.radic108@gmail.com

Introduction: In 2020 Croatia was stuck with two major earthquakes: on March 22nd with epicenter 7 km north of Zagreb city centre and on 29th December with epicenter 5 km south of city of Petrinja (5.5 and 6.2 degrees on the Richter scale respectively). The authors sought to investigate whether these events had an influence on characteristics and number of patients with cardiac chief complaints examined in the Emergency Departments (ED) (1,2).

Patients and Methods: Data on all emergency visits of patients with cardiac chief complaint examined in two University Hospital Centres (UHC) (Sestre Milosrdnice UHC, Zagreb and Zagreb UHC, Zagreb), two University Hospitals (UH) (“Sveti Duh UH, Zagreb and “Merkur” UH, Zagreb) and two regional hospitals (Sisak General Hospital, Sisak and Karlovac General Hospital, Karlovac) examined 7 days prior to earthquake, on the day of each earthquake, and during subsequent 6 days were collected.

Results: In the examined period, there were 5575 ED visits (average age 66 years, female gender 45%), out of which in 1251 (22.4%) cases the chief complaint was cardiac. While in all patients seen after the earthquake only more often primary cardiac diagnosis found was non-anginal chest discomfort (28.8% vs 18.0%; p<0.001), when narrowed down the patients group to only the ones who were located within the 20 kilometers from the epicenter we found that there was significantly more patients with acute myocardial infarction (14.5% vs 22.8%; p= 0.028), acute elevation of blood pressure (10% vs 21.8%, p= 0.001), as well as more paroxysmal arrhythmias treated with electrocardioversion (0.9% vs 4.5%, p=0.022) (Table 1).

TABLE 1 Comparison of patients examined at the emergency department prior to the earthquake and on the day or on days following the earthquake.
Total populationWithin 20 km of epicentre
prior to EQon the day or after the EQPprior to EQon the day or after the EQP
Count (%)Count (%)Count (%)Count (%)
Age72 (65-80)68 (59-79)<0.00171 (59-80)66 (57-76)0.004
Female gender283 (46.9%)277 (42.9%)0.158108 (48.9%)76 (37.6%)0.020
Medical history:
- Hypertension475 (78.9%)407 (63.4%)<0.001182 (82.4%)147 (72.8%)0.018
- Dyslipiedmia247 (41.2%)210 (32.9%)0.00297 (43.9%)87 (43.1%)0.865
- Diabetes120 (20.0%)109 (17.1%)0.18248 (21.8%)44 (21.9%)0.986
- Active smoking125 (23.4%)148 (25.9%)0.33346 (23.0%)58 (32.6%)0.037
- Previous CAD258 (42.8%)210 (32.9%)<0.001110 (49.8%)78 (38.6%)0.021
Admission251 (41.7%)223 (34.6%)0.01089 (40.5%)83 (41.1%)0.895
Time in ED4 (2-7.25)4 (1.5-8)0.0664 (2-6)4 (2.15-8)0.099
Hospital stay5 (3-9)5 (3-7)0.1954 (2-6)4 (2-7)0.448
Non-anginal chest discomfort109 (18.0%)186 (28.8%)<0.00127 (12.2%)19. (9.4%)0.354
Main diagnosis
- Myocardial infarction100 (16.6%)89 (13.8%)0.17032 (14.5%)46 (22.8%)0.028
- Unstable angina32 (5.3%)12 (1.9%)0.00114 (6.3%)5 (2.5%)0.056
- Decompensated HF117 (19.4%)60 (9.3%)<0.00153 (24.0%)22 (10.9%)<0.001
- Arrhythmia114 (18.9%)95 (14.7%)0.04847 (21.3%)34 (16.8%)0.247
- Hypertension117 (19.4%)90 (13.9%)0.01022 (10.0%)44 (21.8%)0.001
Coronary angiography only5 (0.8%)9 (1.4%)0.3411 (0.5%)2 (1.0%)0.510
PCI80 (13.2%)74 (11.5%)0.34128 (12.7%)35 (17.3%)0.179
Electrical cardioversion10 (1.7%)13 (2.0%)0.6362 (0.9%)9 (4.5%)0.022
Mechanical ventilation12 (2.0%)9 (1.4%)0.4175 (2.3%)2 (1.0%)0.306
CPR11 (1.8%)9 (1.4%)0.5494 (1.8%)3 (1.5%)0.794
Inhospital mortality19 (3.2%)13 (2.0%)0.2016 (2.7%)5 (2.5%)0.877
EQ = earthquake; CAD = coronary artery disease; ED = emergency department; HF = heart failure; PCI = percutaneous coronary intervention; CPR = cardiopulmonary resuscitation

Conclusion: In this study, increment in the frequency of cardiac emergencies was detected after a moderate earthquake in patients who were within 20 kilometers of the epicenter. They had significantly more often acute myocardial infarction, acute elevation of blood pressure, as well as paroxysmal arrhythmias treated with electrocardioversion. The health system should be prepared to treat a larger number of cardiac patients in difficult conditions after the earthquake.

LITERATURE

1 

Bazoukis G, Tse G, Naka KK, Kalfakakou V, Vlachos K, Saplaouras A, et al. Impact of major earthquakes on the incidence of acute coronary syndromes - A systematic review of the literature. Hellenic J Cardiol. 2018 September-October;59(5):262–7. https://doi.org/10.1016/j.hjc.2018.05.005 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/29807192

2 

Seizmološka služba pri geofizièkom odsjeku PMF-a. Izvješća o potresima. [Internet]. Available from:https://www.pmf.unizg.hr/geof/seizmoloska_sluzba/izvjesca_o_potresima

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