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Original Research (Original Article) 


Mohammed Abdullah Alhashim et al, 2019;3(1):015–021.

International Journal of Medicine in Developing Countries

The pattern of acute heart failure as an emergency situation in Eastern Saudi Arabia

Mohammed Abdullah Alhashim1*, Hussain Shaker Almazyadi1, Waleed Ibrahim Alshammari2, Mohammed Yousif Alaissawi3, Amina Abduljalil Hasan Abdulla4, Ola Adel Mohamed4, Mahdi Hussain Almubarak5, Abdullah Yahya Alfaifi6, Hassan Ali Alyousef7, Maitham Saeed Alzaer1, May Ebaidan Althibaiti8

Correspondence to: Mohammed Abdullah M. Alhashim

*Medical Intern, Wroclaw Medical University, Wroclaw, Poland.

Email: alhashim50 [at] gmail.com

Full list of author information is available at the end of the article.

Received: 9 December 2018 | Accepted: 15 December 2018


ABSTRACT

Background:

Acute heart failure (HF) is often a potentially life-threatening condition, and emergency treatment is aimed predominantly at managing fluid overload and hemodynamic compromise. The aim of this study was to determine the prevalence rate, causes and risk factor, manifestations, and place of management of acute HF.


Methodology:

This cross-sectional study was conducted among 230 studied populations attending the chronic diseases clinic of five randomly selected primary health care units, during the period of 1 March to 30 June 2018.


Results:

This study found that 32.2% of participants had acute HF. According to causes of heart failure, this study reported, hypertension was the most common cause by 89.2%, followed by coronary heart disease 75.7%, rheumatic valve diseases, cardiomyopathy 27%, myocarditis 24.3%, and congenital heart disease 13.5%. As regard to the manifestations, general weakness 86.5%, dyspnea 81.1%, orthopnea 78.4%, chest pain 73%, tachycardia and palpitation 70.3%, loss of concentration 43.2%, breathlessness and cough with bloody sputum 35.1%, and chest tightness and foamy sputum 27%. Acute HF was more prevalent among males (70.3%) without significant correlations (p > 0.5). Nearly, 59.5% of patients were more than 60 years. Most (51.4%) of cases attended the emergency room then the critical care unit and 43.2% to the internal medicine department. Nearly, 83.8% of cases have been compensated.


Conclusion:

Acute HF was prevalent among chronically ill patients in Dammam and Al-Qatif cities, Eastern Saudi Arabia, more in males and elderly populations. Early and good control of hypertension and coronary heart diseases is recommended.


Keywords:

Acute heart failure, emergency situation, pattern.

Introduction

Heart failure (HF) is a clinical disorder described by a group of stars of symptoms (dyspnea, orthopnea, and bring down appendage swelling) and signs (elevated jugular venous pressure and pulmonary congestion) frequently caused by an auxiliary or potentially utilitarian cardiovascular irregularity bringing about diminished heart yield and additionally raised intra cardiovascular pressures [1]. The incidence of HF after 30 years of pronounced increased rates, nowadays seems to have reached a plateau [2]. The syndrome’s prevalence in the USA in 2012 was 5.7 million, representing 2.2% of the population [3]. Comparably, data from countries in Europe showed that 1%–2% of the European population suffers from the syndrome [4].

Acute heart failure is comprehensively characterized as a fast beginning of new or intensifying signs and symptoms of HF [5]. It is frequently a conceivably dangerous condition, requiring hospitalization, and emergency treatment are aimed predominantly at managing fluid overload and hemodynamic compromise. Several criteria have been proposed to diagnose HF; these include, in particular, the Framingham criteria [6], the Boston criteria [7], the Gothenburg criteria [8], and the European Society of Cardiology criteria [9]. All depend on similar indicators of symptoms and raised filling pressures and consolidate information from restorative history, physical examination, and chest radiograph. The introduction and the executives of patients giving intense heart disappointment acute heart failure (AHF) are less surely known. These patients present with a quick beginning of sickness, regularly with regards to the previous cardiomyopathy, and their admission to doctor’s facility proclaims a poor guess with a high danger of readmission and passing post-release [10]. The aim of this study was to determine the prevalence rate, causes and risk factor, and manifestations and place of management of acute HF cases in the population of Dammam and Qatef cities eastern Saudi Arabia.

Subjects and Methods

A cross-sectional study was carried out on 230 studied populations attending the chronic diseases clinic of five randomly selected primary health care units in Dammam and Al-Qatif cities, Eastern Saudi Arabia. This study was conducted during the period of 1 March to 30 June 2018, on the general population of Arar, KSA.

The sample size was calculated using the sample size equation: n = z2 p(1 − p)/e2, considering the target population of more than 1,000, and study power 95%. Systematic random sampling technique was followed. After identifying the first participant randomly, every fifth was included. All the adult subjects were invited till the required sample was covered.

Data were collected through personal interviews with the sampled population and filling the questionnaire after a brief introduction or explanation of the idea of the research. A predesigned questionnaire was used for data collection and included inquiries about socio-demographic characteristics such as age, sex, educational status, and marital status. The questionnaire also included questions regarding the previous history of attack of acute HF with detailed questions about the symptoms of acute HF and causes, risk factors and place of management of his/her attack of acute HF after ensuring the diagnosis by reviewing the accompanied health records and prescriptions and asking the accompanied caregivers about the case. Exclusion criteria included patients who refused to participate in the study.

Collected data were coded and analyzed using statistical package for the social sciences (SPSS Inc., Chicago, Illinois) version 22. Descriptive statistics for the prevalence and quantitative variables were used. The relation between acute HF and other variables was determined using the chi-square test. p-value of lower than 0.05 was considered statistically
significant.

Results

The study included 230 participants, out of which 69.6% were males and 30.4% were females. There were 57.4% married and 13% were single. More than half of participants were not working 58.3%. The majority 30.4% were university education or more and 22.6% were illiterate. Acute heart failure was reported in 32.2% of cases. Table 1 shows socio-demographic characters of study population.

Table 1. Socio-demographic characters of study populations, Dammam and Al-Qatif cities, Eastern Saudi Arabia, 2018.

Variable Frequency (total = 230) Percent (%)
Age group
< 30 24 10.4
30–40 18 7.8
41–60 68 29.6
>60 120 52.2
Sex
Female 70 30.4
Male 160 69.6
Marital status
Widow 54 23.5
Single 30 13.0
Married 132 57.4
Divorced 14 6.1
Working status
Not working 134 58.3
Working 96 41.7
Educational level
Illiterate 52 22.6
Primary 32 13.9
Secondary 46 20.0
University or more 70 30.4
Preparatory 30 13.0
Acute heart failure
Yes 74 32.2
No 156 67.8

Table 2. Causes, Type, Manifestations, management, and compensation in the studied acute heart failure cases (N = 74).

Manifestations of heart failure No. %
Symptoms
General weakness 64 86.5
Dyspnea 60 81.1
Orthopnea 58 78.4
Chest pain 54 73.0
Tachycardia and palpitation 52 70.3
Breathlessness and cough with bloody sputum 26 35.1
Chest tightness and foamy sputum 20 27.0
Vomiting 34 45.9
Ascites 30 40.5
Occult edema 32 43.2
Loss of concentration 32 43.2
Causes of heart failure
Hypertension 66 89.2
Coronary heart diseases 56 75.7
Rheumatic valve diseases 20 27.0
Cardiomyopathy 20 27.0
Myocarditis 18 24.3
Congenital heart disease 10 13.5
Risk factors
DM 52 70.3
Drugs 66 89.2
Smoking 42 56.8
Morbid obesity 22 29.7
Alcohol 6 8.1
Type of heart failure
Diastolic heart failure 10 13.5
Systolic heart failure 14 18.9
Left-sided failure 20 27.0
Congestive heart failure 20 27.0
Don’t know 10 13.5
Hospital admission and place of management in the hospital
The emergency room then the critical care unit 38 51.4
Internal medicine department 32 43.2
Causes of an emergency visit
Dyspnea and chest pain 34 45.9
Fast or irregular heartbeat accompanied by chest tightness 14 18.9
Sudden difficulty in the breath and cough with bloody sputum 2 2.7
Fainting or severe weakness 8 10.8
Cardiac compensation
Decompensated 12 16.2
Compensated 62 83.8
Complications of AHF 12 16.2

Regarding to manifestations of acute HF this study reported, general weakness 86.5%, dyspnea 81.1%, orthopnea 78.4%, chest pain 73%, tachycardia and palpitation 70.3%, loss of concentration 43.2%, breathlessness and cough with bloody sputum 35.1%, chest tightness and foamy sputum 27%, vomiting 45.9%, and ascites 40.5%. Table 2 shows causes, type, manifestations, management and compensation in the studied acute HF cases. According to the causes of HF, this study reported, hypertension and drugs were the most common causes for heart failure by 89.2% for both followed by coronary heart disease 75.7%, rheumatic valve diseases and cardiomyopathy 27%, myocarditis 24.3%, congenital heart disease 13.5% and risk factors included diabetes mellitus (DM) 70.3%, smoking 56.8%, morbid obesity 29.7%, and only 8.1% for alcohol. Regarding the place of management 51.4% of cases entered, the emergency room then the critical care unit and 43.2% to the internal medicine department. Nearly, 83.8% of cases have been compensated. The complication of acute HF was reported in 16.2% of cases.

A significant relation was found between acute heart failure and age group (p = 0.001), material status (p = 0.014); however, there was no significant relation with gender (p = 0.5), working status (p = 0.1), and educational level (p = 0.2). Table 3 shows the relationship between physicians diagnosed with acute heart failure and sex, age group, marital status, and educational level in the studied population.

Discussion

Acute HF is defined as a rapid onset of new or worsening symptoms of HF [10]. It is frequently a possibly dangerous condition, requiring hospitalization, and emergency treatment is aimed predominantly at managing fluid overload and hemodynamic compromise. This study found that 32.2% of participants had acute heart failure. This was less than another study that was conducted among 3,580 participants who reported, 37.1% of them had acute heart failure [11]. This result was near another prospective, multicenter, observational survey conducted among 5,118 patients, of which 1,892 (37%) were admitted for acute HF [12]. Another study reported a high prevalence rate for acute HF, where 40.5% of cases had acute HF [13]. Another study reported acute heart failure by 43% [14]. In India, another study conducted among 1,205 patients found that the prevalence of acute heart failure was 39.7% [15].

As regards the relations of acute heart failure with gender and age, the present study found that the acute HF was more prevalent among males by 70.3% without significant correlations (p = 0.5). However, there were significant relations with age (p = 0.001), and 59.5% of patients were more than 60 years of age. Another study reported that the mean age of the patient with acute HF was 70.5 years, and it was more prevalent among males by 57.3%. In contrast to the current result, the previous study found a significant relation with age and gender
(p = 0.01) and (p = 0.001), respectively [11]. Another study reported that the mean age of patients with AHF was 73 years with statistical significance (p = 0.01), and 59% of them were males (p = 0.02) [16].

Table 3. The relationship between physicians diagnosed Acute Heart Failure and sex, age group, marital status and educational level in the studied elderly population, Arar, 2017.

Responses Acute Heart Failure Total (N = 230) p value
Yes (N = 74) No (N = 156)
Sex Female 22 48 70 0.501
29.7% 30.8% 30.4%
Male 52 108 160
70.3% 69.2% 69.6%
Age group <30 0 24 24 0.001
.0% 15.4% 10.4%
30–40 10 8 18
13.5% 5.1% 7.8%
41–60 20 48 68
27.0% 30.8% 29.6%
>60 44 76 120
59.5% 48.7% 52.2%
Marital status Widow 20 34 54 0.014
27.0% 21.8% 23.5%
Single 2 28 30
2.7% 17.9% 13.0%
Married 48 84 132
64.9% 53.8% 57.4%
Divorced 4 10 14
5.4% 6.4% 6.1%
Working status Not working 48 86 134 0.104
64.9% 55.1% 58.3%
Working 26 70 96
35.1% 44.9% 41.7%
Educational level Primary 10 22 32 0.201
13.5% 14.1% 13.9%
Illiterate 18 34 52
24.3% 21.8% 22.6%
Secondary 16 30 46
21.6% 19.2% 20.0%
University or more 16 54 70
21.6% 34.6% 30.4%
Preparatory 14 16 30
18.9% 10.3% 13.0%

According to the causes of heart failure, this study reported, hypertension and drugs were the most common causes for heart failure by 89.2% for both followed by coronary heart disease 75.7%, rheumatic valve diseases and cardiomyopathy 27%, myocarditis 24.3%, congenital heart disease 13.5% and risk factors included DM 70.3%, smoking 56.8%, morbid obesity 29.7%, and only 8.1% for alcohol. Similar to these results, another study found that hypertension was the most common causes for HF by (45.4%) followed by idiopathic dilated cardiomyopathy 18.8%, rheumatic heart disease (14.3%) and ischemic heart disease (7.7%) was not a common cause of AHF [17]. Kingue et al. [18] reported main reasons for HF were: hypertension (54.49%), cardiomyopathies (26.34%), valvular heart diseases (24.55%), and ischemic heart disease (2.39%). However, another study conducted by Oyoo and Ogola [19] found that the leading cause of heart failure was rheumatic heart disease (32%), followed by dilated cardiomyopathy (25%) and hypertensive heart disease (17%). Another study reported 42% of patient had heart failure due to acute coronary syndromes followed by arrhythmia 32.2%, valvular cause 20.8%, and infection 15% [11]. Another study reported the main cause of AHF was ischemic heart disease (61%) followed by valvular heart disease 21%, and 15% for both dilated cardiomyopathy and hypertensive and hypertrophic cardiomyopathy [16]. In Egypt, another study reported coronary artery disease was the most common etiology of heart failure 49.5%, 13.6% of patients had dilated cardiomyopathy, valvular heart disease was incremented as the etiology in 15.5% of the patients, 0.9% had postpartum cardiomyopathy, while 20% of patients did not have a specified etiology for heart failure [20]. Also, in Riyadh, another study found that the primary etiologies of HF were coronary artery disease CAD (59.3%), idiopathic dilated cardiomyopathy (20.6%), hypertension (8.2%), cardiotoxic cardiomyopathy (2.5), primary valvular heart disease (7.6%), pregnancy-related cardiomyopathy (1%), and thyroid disorder related cardiomyopathy (1%) [21].

Regarding to the manifestations of heart failure this study reported, general weakness 86.5%, dyspnea 81.1%, orthopnea 78.4%, chest pain 73%, tachycardia and palpitation 70.3%, loss of concentration 43.2%, vomiting 45.9%, ascites 40.5%, breathlessness and cough with bloody sputum 35.1%, chest tightness and foamy sputum 27%. Another study reported dyspnea was a constant symptom of HF (95.20%) [1]. Another study was conducted among 581 patients reported that the pulmonary edema was the most common symptom 82% followed by cardiogenic shock 29%, peripheral edema 27%, arrhythmia 23%, hepatomegaly 20%, angina 14%, and 4% for syncope [4]. A global survey on AHF collected anonymized data from 4,953 patients in nine countries found that the presenting symptoms and clinical findings were dyspnea at rest (73%), pulmonary rales (61%), orthopnea (56%), fatigue (44%), peripheral edema (43%), raised jugular venous pressure (40%), cold extremities (26%), and weight gain (25%) [20]. Another study reported that 66% of patients of HF presented by dyspnea as the main complaint, while 22% reported fatigue and 10.8% reported chest pain [21].

According to the type of heart failure, this study reported left side failure and congestive heart failure by 27%, systolic heart failure at 18.9%, and diastolic by 13.5%. Another study divided AHF patients according to the guidelines of clinical classification in to decompensated HF (65%), pulmonary edema (16%) which meant that HF accompanied by alveolar edema, hypertensive HF (11%), cardiogenic shock referred to AHF accompanied by low blood pressure and oliguria or low cardiac index reported by (4%), and right side HF (3%) [22]. Another study reported, decompensated congestive HF (38.6%), pulmonary oedema (36.7%), cardiogenic shock (11.7%), hypertensive HF (7.4%), right HF (4.5%), and high-output HF (1.1%) [20].

One limitation of this study was that it was based on only a small sample of population mainly males because the data collectors were males and the restrictions to interview foreign females. And, it included survivors only, not all acute heart failure cases, assure there were deaths, which were not included, and they may be greater in number than saved life cases. The strength of this study is that it shows the epidemiological pattern of AHF.

Conclusion

Acute HF was prevalent among chronically ill patients in Dammam and Al-Qatif cities, Eastern Saudi Arabia, more in males and elderly populations. Early and good control of hypertension and coronary heart diseases is recommended. Also, we recommend that policymakers must condense their efforts to increase the awareness campaigns to protect and treat those hypertensive patients and all the groups of the population who are at high risk from this disease and its subsequent morbidities. Also, we recommend a large scale community-based study about the disease in all areas of Saudi Arabia.

List of Abbreviations

AHF Acute heart failure

DM Diabetes mellitus


Consent for publication

Informed consent was obtained from all participants.


Funding

None.


Declaration of conflicting interests

The authors declare that there is no conflict of interest regarding the publication of this article.


Author details

Mohammed Abdullah Alhashim1, Hussain Shaker Almazyadi1, Waleed Ibrahim Alshammari2, Mohammed Yousif Alaissawi3, Amina Abduljalil Hasan Abdulla4, Ola Adel Mohamed4, Mahdi Hussain Almubarak5, Abdullah Yahya Alfaifi6, Hassan Ali Alyousef7, Maitham Saeed Alzaer1, May Ebaidan Althibaiti8

  1. Wroclaw Medical University, Wroclaw, Poland
  2. Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
  3. Medical University of Lublin, Lublin, Poland
  4. Southeast University is in Nanjiing , China
  5. The Medical University of Silesia, Katowice, Poland
  6. Jazan University, Jazan, Saudi Arabia
  7. Alfaisal University, Riyadh, Saudi Arabia
  8. Taif University, Taif, Saudi Arabia

REFERENCES

  1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200. https://doi.org/10.1093/eurheartj/ehw128
  2. Maggioni AP, Dahlström U, Filippatos G, Chioncel O, Crespo Leiro M, Drozdz J, et al., Heart Failure Association of the European Society of Cardiology (HFA). EURObservational Research Programme: regional differences and 1‐year follow‐up results of the Heart Failure Pilot Survey (ESC‐HF Pilot). Eur J Heart Fail. 2013;15:808–17. https://doi.org/10.1093/eurjhf/hft050
  3. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics–2015 update: a report from the American Heart Association. Circulation. 2015;131:e29–322. https://doi.org/10.1161/CIR.0000000000000152
  4. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18:891–975. https://doi.org/10.1002/ejhf.592
  5. Gheorghiade M, Zannad F, Sopko G, Klein L, Pina IL, Konstam MA, et al. Acute heart failure syndromes: current state and framework for future research. Circulation. 2005;112(25):3958–68. https://doi.org/10.1161/CIRCULATIONAHA.105.590091
  6. McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure: the Framingham study. N Engl J Med. 1971;285:1441–6. https://doi.org/10.1056/NEJM197112232852601
  7. Carlson KJ, Lee DC, Goroll AH, Leahy M, Johnson RA. An analysis of physicians’ reasons for prescribing long-term digitalis therapy in outpatients. J Chronic Dis. 1985;38:733–9. https://doi.org/10.1016/0021-9681(85)90115-8
  8. Eriksson H, Caidahl K, Larsson B, Ohlson LO, Welin L, Wilhelmsen L, et al. Cardiac and pulmonary causes of dyspnoea—validation of a scoring test for clinical-epidemiological use: the Study of Men Born in 1913. Eur Heart J. 1987;8:1007–14. https://doi.org/10.1093/oxfordjournals.eurheartj.a062365
  9. Swedberg K, Cleland J, Dargie H, Drexler H, Follath F, Komajda M, et al. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): the Task Force for the Diagnosis and treatment of Chronic Heart Failure of the European Society of Cardiology. Eur Heart J. 2005;26:1115–40. https://doi.org/10.1093/eurheartj/ehi204
  10. Kurmani S, Squire I. Acute heart failure: definition, classification, and epidemiology. Curr Heart Fail Rep. 2017;14(5):385–92. https://doi.org/10.1007/s11897-017-0351-y
  11. Nieminen MS, Brutsaert D, Dickstein K, Drexler H, Follath F, Harjola VP, et al. EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J. 2006;27:2725–36. https://doi.org/10.1093/eurheartj/ehl193
  12. Maggioni AP, Dahlström U, Filippatos G, Chioncel O, Leiro MC, Drozdz J, et al. EURObservational Research Programme: the Heart Failure Pilot Survey (ESC‐HF Pilot). Eur J Heart Fail. 2010;12:1076–84. https://doi.org/10.1093/eurjhf/hfq154
  13. Maggioni AP, Anker SD, Dahlström U, Filippatos G, Ponikowski P, Zannad F, et al. Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12 440 patients of the ESC Heart Failure Long‐Term Registry. Eur J Heart Fail. 2013;15:1173–84. https://doi.org/10.1093/eurjhf/hft134
  14. Stewart S, Wilkinson D, Hansen C, Vaghela V, Mvungi R, McMurray J, Sliwa K. Predominance of heart failure in the Heart of Soweto Study cohort: emerging challenges for urban African communities. Circulation. 2008;118(23):2360–7. https://doi.org/10.1161/CIRCULATIONAHA.108.786244
  15. Harikrishnan S, Sanjay G, Anees T, Viswanathan S, Vijayaraghavan G, Bahuleyan CG, et al. Clinical presentation, management, in‐hospital and 90‐day outcomes of heart failure patients in Trivandrum, Kerala, India: the Trivandrum Heart Failure Registry. Eur J Heart Fail. 2015;17:794–800. https://doi.org/10.1002/ejhf.283
  16. Zannad F, Mebazaa A, Juillière Y, Cohen‐Solal A, Guize L, Alla F, et al. Clinical profile, contemporary management and one‐year mortality in patients with severe acute heart failure syndromes: the EFICA study. Eur J Heart Fail. 2016;8:697–705. https://doi.org/10.1016/j.ejheart.2006.01.001
  17. Damasceno A, Mayosi BM, Sani M, Ogah OS, Mondo C, Ojji D, et al. The causes, treatment, and outcome of acute heart failure in 1006 Africans from 9 countries. Results of the Sub-Saharan Africa Survey of Heart Failure. Arch Intern Med. 2012;172(18):1386–94. https://doi.org/10.1001/archinternmed.2012.3310
  18. Kingue S, Dzudie A, Menanga A, Akono M, Ouankou M, Muna W. A new look at adult chronic heart failure in Africa in the age of the Doppler echocardiography: the experience of the medicine department at Yaounde General Hospital (in French). Ann Cardiol Angeiol (Paris). 2005;54:276–83. https://doi.org/10.1016/j.ancard.2005.04.014
  19. Oyoo GO, Ogola EN. Clinical and socio demographic aspects of congestive heart failure patients at Kenyatta National Hospital, Nairobi. East Afr Med J. 1999;76:23–7.
  20. Hozayen S, Sabet S, El Ramly M, El Naggar W, Farag N, Raymond R, et al. Characteristics and outcome of acute heart failure patients in Egypt. HMJ. 2009;3:92–7.
  21. Elasfar, Abdelfatah, AlShaghaa W, Abdulaal M. Frequency of risk factors and aetiologies for heart failure in Saudi Arabia: a hospital-based study. Egypt Heart J. 2014;66:1–35. https://doi.org/10.1016/j.ehj.2013.12.034
  22. Kazemi T, Sharifzadeh G, Zarban A, Fesharakinia A. Comparison of components of metabolic syndrome in premature myocardial infarction in an Iranian population: a case-control study. Int J Prev Med. 2013;4:110–4.


How to Cite this Article
Pubmed Style

Alhashim MA, Almazyadi HS, Alshammari WI, Alaissawi MY, Abdulla AAH, Mohammed OA, Almubarak MH, Alfaifi AY, Alyousef HA, Alzaer MS, Althibaiti ME, . The pattern of acute heart failure as an emergency situation in Eastern Saudi Arabia. IJMDC. 2019; 3(1): 15-21. doi:10.24911/IJMDC.51-1544370583


Web Style

Alhashim MA, Almazyadi HS, Alshammari WI, Alaissawi MY, Abdulla AAH, Mohammed OA, Almubarak MH, Alfaifi AY, Alyousef HA, Alzaer MS, Althibaiti ME, . The pattern of acute heart failure as an emergency situation in Eastern Saudi Arabia. https://www.ijmdc.com/?mno=20882 [Access: January 28, 2022]. doi:10.24911/IJMDC.51-1544370583


AMA (American Medical Association) Style

Alhashim MA, Almazyadi HS, Alshammari WI, Alaissawi MY, Abdulla AAH, Mohammed OA, Almubarak MH, Alfaifi AY, Alyousef HA, Alzaer MS, Althibaiti ME, . The pattern of acute heart failure as an emergency situation in Eastern Saudi Arabia. IJMDC. 2019; 3(1): 15-21. doi:10.24911/IJMDC.51-1544370583



Vancouver/ICMJE Style

Alhashim MA, Almazyadi HS, Alshammari WI, Alaissawi MY, Abdulla AAH, Mohammed OA, Almubarak MH, Alfaifi AY, Alyousef HA, Alzaer MS, Althibaiti ME, . The pattern of acute heart failure as an emergency situation in Eastern Saudi Arabia. IJMDC. (2019), [cited January 28, 2022]; 3(1): 15-21. doi:10.24911/IJMDC.51-1544370583



Harvard Style

Alhashim, M. A., Almazyadi, . H. S., Alshammari, . W. I., Alaissawi, . M. Y., Abdulla, . A. A. H., Mohammed, . O. A., Almubarak, . M. H., Alfaifi, . A. Y., Alyousef, . H. A., Alzaer, . M. S., Althibaiti, . M. E. & (2019) The pattern of acute heart failure as an emergency situation in Eastern Saudi Arabia. IJMDC, 3 (1), 15-21. doi:10.24911/IJMDC.51-1544370583



Turabian Style

Alhashim, Mohammed Abdullah, Hussain Shaker Almazyadi, Waleed Ibrahim Alshammari, Mohammed Yousif Alaissawi, Amina Abduljalil Hasan Abdulla, Ola Adel Mohammed, Mahdi Hussain Almubarak, Abdullah Yahya Alfaifi, Hassan Ali Alyousef, Maitham Saeed Alzaer, May Ebaidan Althibaiti, and . 2019. The pattern of acute heart failure as an emergency situation in Eastern Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (1), 15-21. doi:10.24911/IJMDC.51-1544370583



Chicago Style

Alhashim, Mohammed Abdullah, Hussain Shaker Almazyadi, Waleed Ibrahim Alshammari, Mohammed Yousif Alaissawi, Amina Abduljalil Hasan Abdulla, Ola Adel Mohammed, Mahdi Hussain Almubarak, Abdullah Yahya Alfaifi, Hassan Ali Alyousef, Maitham Saeed Alzaer, May Ebaidan Althibaiti, and . "The pattern of acute heart failure as an emergency situation in Eastern Saudi Arabia." International Journal of Medicine in Developing Countries 3 (2019), 15-21. doi:10.24911/IJMDC.51-1544370583



MLA (The Modern Language Association) Style

Alhashim, Mohammed Abdullah, Hussain Shaker Almazyadi, Waleed Ibrahim Alshammari, Mohammed Yousif Alaissawi, Amina Abduljalil Hasan Abdulla, Ola Adel Mohammed, Mahdi Hussain Almubarak, Abdullah Yahya Alfaifi, Hassan Ali Alyousef, Maitham Saeed Alzaer, May Ebaidan Althibaiti, and . "The pattern of acute heart failure as an emergency situation in Eastern Saudi Arabia." International Journal of Medicine in Developing Countries 3.1 (2019), 15-21. Print. doi:10.24911/IJMDC.51-1544370583



APA (American Psychological Association) Style

Alhashim, M. A., Almazyadi, . H. S., Alshammari, . W. I., Alaissawi, . M. Y., Abdulla, . A. A. H., Mohammed, . O. A., Almubarak, . M. H., Alfaifi, . A. Y., Alyousef, . H. A., Alzaer, . M. S., Althibaiti, . M. E. & (2019) The pattern of acute heart failure as an emergency situation in Eastern Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (1), 15-21. doi:10.24911/IJMDC.51-1544370583