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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Sciences in Medicine (Emergency Medicine) Johannesburg, 2014 / Background: Patients with acute coronary syndrome (ACS) may present with a wide range of symptoms that may easily be misdiagnosed. Methods: This cross-sectional, hospital-based, descriptive, retrospective audit of medical records was based at the Ladysmith Provincial Hospital ED and consisted of the last 160 consecutive patients (from the date of initiation of data collection) with accessible medical records and with a final hospital discharge diagnosis of ACS. Results: The frequency of patients presenting with ACS was approximately 53 patients per annum. There was a male to female ratio of 1.3: 1. The mean age was 55.8 years (SD 12.8 years). The study population consisted of Asian (103/160, 64.4%), black (36/160, 22.5%) and white (21/160, 13.1%). The majority of the study patients were unemployed (98/160, 61.25%), urban resident (143/160, 89.4%), not alcohol users (137/160, 85.6%), and not smokers (88/160, 55.0%). Risk factors and comorbidity included previous acute coronary syndrome (44/160, 27.5%), family history (29/160, 18.1%), previous cardiovascular surgery (10/160, 6.25%), obesity (45/160, 28.1%), hypercholesterolemia (49/160, 30.6%), diabetes (42/160, 26.25%), hypertension (76/160, 47.5%), and renal failure (27/160, 16.9%). Approximately three quarters (119/160, 74.4%) of the study patients had typical chest pain, 16.3% (26/160) had atypical chest pain, and 9.4% (15/160) had no chest pain. The median length of hospital stay was 3 days and the in-hospital mortality was 8.1 % (13/160). Conclusion: The relatively high frequency of ACS reported in this study, when compared to other similar studies, is concerning. Also of concern in this study, is the alarming proportion of Asians that presented with ACS.

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Atherosclerotic plaque caps are composed of a composite soft tissue material that becomes subjected to cyclic loading under stenotic flow conditions. The cyclic loading causes the plaque cap to fatigue and eventually fail. The hypothesis of this work is that arteries and plaque caps may fatigue which may be predicted by a stress vs. number of cycles (S-N) curve. The S-N curve has not been determined for almost any biological soft tissue. The Specific Aim of the thesis is to quantify an S-N curve for normal arterial soft tissue collected from cyclic tension testing. Coronary arteries from porcine hearts will be tested as a material that closely models the plaque cap in non-linear elastic behavior. The S-N curve will be developed through failure testing with multiple cycles at stresses between 0.5 and 5 MPa.

Thesis (M. Med. Sc.)--University of Hong Kong, 2009. / Includes bibliographical references (p. 37-42).

Thesis (M. Med. Sc.)--University of Queensland, 2003. / Includes bibliographical references.