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

    Authors

    Abstract

    **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 population** | **Total population** | **Total population** | **Within 20 km of epicentre** | **Within 20 km of epicentre** | **Within 20 km of epicentre** | | --- | --- | --- | --- | --- | --- | --- | | | **prior to EQ** | **on the day or after the EQ** | **P** | **prior to EQ** | **on the day or after the EQ** | **P** | | | **Count (%)** | **Count (%)** | | **Count (%)** | **Count (%)** | | | Age | 72 (65-80) | 68 (59-79) | <0.001 | 71 (59-80) | 66 (57-76) | 0.004 | | Female gender | 283 (46.9%) | 277 (42.9%) | 0.158 | 108 (48.9%) | 76 (37.6%) | 0.020 | | Medical history: | | | | | | | | - Hypertension | 475 (78.9%) | 407 (63.4%) | <0.001 | 182 (82.4%) | 147 (72.8%) | 0.018 | | - Dyslipiedmia | 247 (41.2%) | 210 (32.9%) | 0.002 | 97 (43.9%) | 87 (43.1%) | 0.865 | | - Diabetes | 120 (20.0%) | 109 (17.1%) | 0.182 | 48 (21.8%) | 44 (21.9%) | 0.986 | | - Active smoking | 125 (23.4%) | 148 (25.9%) | 0.333 | 46 (23.0%) | 58 (32.6%) | 0.037 | | - Previous CAD | 258 (42.8%) | 210 (32.9%) | <0.001 | 110 (49.8%) | 78 (38.6%) | 0.021 | | Admission | 251 (41.7%) | 223 (34.6%) | 0.010 | 89 (40.5%) | 83 (41.1%) | 0.895 | | Time in ED | 4 (2-7.25) | 4 (1.5-8) | 0.066 | 4 (2-6) | 4 (2.15-8) | 0.099 | | Hospital stay | 5 (3-9) | 5 (3-7) | 0.195 | 4 (2-6) | 4 (2-7) | 0.448 | | Non-anginal chest discomfort | 109 (18.0%) | 186 (28.8%) | <0.001 | 27 (12.2%) | 19. (9.4%) | 0.354 | | Main diagnosis | | | | | | | | - Myocardial infarction | 100 (16.6%) | 89 (13.8%) | 0.170 | 32 (14.5%) | 46 (22.8%) | 0.028 | | - Unstable angina | 32 (5.3%) | 12 (1.9%) | 0.001 | 14 (6.3%) | 5 (2.5%) | 0.056 | | - Decompensated HF | 117 (19.4%) | 60 (9.3%) | <0.001 | 53 (24.0%) | 22 (10.9%) | <0.001 | | - Arrhythmia | 114 (18.9%) | 95 (14.7%) | 0.048 | 47 (21.3%) | 34 (16.8%) | 0.247 | | - Hypertension | 117 (19.4%) | 90 (13.9%) | 0.010 | 22 (10.0%) | 44 (21.8%) | 0.001 | | Coronary angiography only | 5 (0.8%) | 9 (1.4%) | 0.341 | 1 (0.5%) | 2 (1.0%) | 0.510 | | PCI | 80 (13.2%) | 74 (11.5%) | 0.341 | 28 (12.7%) | 35 (17.3%) | 0.179 | | Electrical cardioversion | 10 (1.7%) | 13 (2.0%) | 0.636 | 2 (0.9%) | 9 (4.5%) | 0.022 | | Mechanical ventilation | 12 (2.0%) | 9 (1.4%) | 0.417 | 5 (2.3%) | 2 (1.0%) | 0.306 | | CPR | 11 (1.8%) | 9 (1.4%) | 0.549 | 4 (1.8%) | 3 (1.5%) | 0.794 | | Inhospital mortality | 19 (3.2%) | 13 (2.0%) | 0.201 | 6 (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.

    Keywords

    earthquake, cardiac emergencies, emergency department

    DOI

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

    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
    2. Seizmološka služba pri geofizièkom odsjeku PMF-a. Izvješća o potresima. [Internet]. https://www.pmf.unizg.hr/geof/seizmoloska_sluzba/izvjesca_o_potresima
    Cardiologia Croatica
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    Cardiac emergencies in the emergency department after the 2020 earthquake – Croatian experiences

    Extended Abstract
    Issue9-10
    Published
    Pages288-289
    PDF via DOIhttps://doi.org/10.15836/ccar2022.288
    earthquake
    cardiac emergencies
    emergency department

    Authors

    Zdravko BabićORCIDSestre Milosrdnice University Hospital Centre, Zagreb, Croatia
    Marin PavlovORCIDDubrava University Hospital, Zagreb, Croatia
    Petra Radić*ORCIDSestre Milosrdnice University Hospital Centre, Zagreb, Croatia
    Jozica ŠikićORCIDUniversity of Zagreb, Zagreb, Croatia
    Edvard GalićORCIDUniversity of Zagreb, Zagreb, Croatia
    Tomislav LetilovićORCIDUniversity of Zagreb, Zagreb, Croatia
    Diana BalenovićORCIDSisak General Hospital, Sisak, Croatia
    Davor HorvatORCIDKarlovac General Hospital, Karlovac, Croatia
    Luka PerčinORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Dubravka ŠipušORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Valentina ObadićORCID“Merkur” University Hospital, Zagreb, Croatia
    Davor MiličićORCIDUniversity of Zagreb, Zagreb, Croatia

    *Correspondence email: petra.radic108@gmail.com

    Abstract

    **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 population** | **Total population** | **Total population** | **Within 20 km of epicentre** | **Within 20 km of epicentre** | **Within 20 km of epicentre** | | --- | --- | --- | --- | --- | --- | --- | | | **prior to EQ** | **on the day or after the EQ** | **P** | **prior to EQ** | **on the day or after the EQ** | **P** | | | **Count (%)** | **Count (%)** | | **Count (%)** | **Count (%)** | | | Age | 72 (65-80) | 68 (59-79) | <0.001 | 71 (59-80) | 66 (57-76) | 0.004 | | Female gender | 283 (46.9%) | 277 (42.9%) | 0.158 | 108 (48.9%) | 76 (37.6%) | 0.020 | | Medical history: | | | | | | | | - Hypertension | 475 (78.9%) | 407 (63.4%) | <0.001 | 182 (82.4%) | 147 (72.8%) | 0.018 | | - Dyslipiedmia | 247 (41.2%) | 210 (32.9%) | 0.002 | 97 (43.9%) | 87 (43.1%) | 0.865 | | - Diabetes | 120 (20.0%) | 109 (17.1%) | 0.182 | 48 (21.8%) | 44 (21.9%) | 0.986 | | - Active smoking | 125 (23.4%) | 148 (25.9%) | 0.333 | 46 (23.0%) | 58 (32.6%) | 0.037 | | - Previous CAD | 258 (42.8%) | 210 (32.9%) | <0.001 | 110 (49.8%) | 78 (38.6%) | 0.021 | | Admission | 251 (41.7%) | 223 (34.6%) | 0.010 | 89 (40.5%) | 83 (41.1%) | 0.895 | | Time in ED | 4 (2-7.25) | 4 (1.5-8) | 0.066 | 4 (2-6) | 4 (2.15-8) | 0.099 | | Hospital stay | 5 (3-9) | 5 (3-7) | 0.195 | 4 (2-6) | 4 (2-7) | 0.448 | | Non-anginal chest discomfort | 109 (18.0%) | 186 (28.8%) | <0.001 | 27 (12.2%) | 19. (9.4%) | 0.354 | | Main diagnosis | | | | | | | | - Myocardial infarction | 100 (16.6%) | 89 (13.8%) | 0.170 | 32 (14.5%) | 46 (22.8%) | 0.028 | | - Unstable angina | 32 (5.3%) | 12 (1.9%) | 0.001 | 14 (6.3%) | 5 (2.5%) | 0.056 | | - Decompensated HF | 117 (19.4%) | 60 (9.3%) | <0.001 | 53 (24.0%) | 22 (10.9%) | <0.001 | | - Arrhythmia | 114 (18.9%) | 95 (14.7%) | 0.048 | 47 (21.3%) | 34 (16.8%) | 0.247 | | - Hypertension | 117 (19.4%) | 90 (13.9%) | 0.010 | 22 (10.0%) | 44 (21.8%) | 0.001 | | Coronary angiography only | 5 (0.8%) | 9 (1.4%) | 0.341 | 1 (0.5%) | 2 (1.0%) | 0.510 | | PCI | 80 (13.2%) | 74 (11.5%) | 0.341 | 28 (12.7%) | 35 (17.3%) | 0.179 | | Electrical cardioversion | 10 (1.7%) | 13 (2.0%) | 0.636 | 2 (0.9%) | 9 (4.5%) | 0.022 | | Mechanical ventilation | 12 (2.0%) | 9 (1.4%) | 0.417 | 5 (2.3%) | 2 (1.0%) | 0.306 | | CPR | 11 (1.8%) | 9 (1.4%) | 0.549 | 4 (1.8%) | 3 (1.5%) | 0.794 | | Inhospital mortality | 19 (3.2%) | 13 (2.0%) | 0.201 | 6 (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. 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.DOI
    2. 2.
      Seizmološka služba pri geofizièkom odsjeku PMF-a. Izvješća o potresima. [Internet].Link