CC Cardiol Croat Cardiologia Croatica Cardiol. Croat. 1848-543X 1848-5448 Croatian Cardiac Society CC 2022 17_9-10_288-9 10.15836/ccar2022.288 Extended Abstract Acute and intensive cardiology Cardiac emergencies in the emergency department after the 2020 earthquake – Croatian experiences https://orcid.org/0000-0002-7060-8375BabićZdravko12 https://orcid.org/0000-0003-3962-2774PavlovMarin3 https://orcid.org/0000-0002-4842-7156RadićPetra1* https://orcid.org/0000-0003-4488-0559ŠikićJozica24 https://orcid.org/0000-0002-5707-0961GalićEdvard24 https://orcid.org/0000-0003-1229-7983LetilovićTomislav25 https://orcid.org/0000-0001-8182-6848BalenovićDiana6 https://orcid.org/0000-0003-2360-5793HorvatDavor7 https://orcid.org/0000-0003-0497-6871PerčinLuka8 https://orcid.org/0000-0002-5631-0353ŠipušDubravka8 https://orcid.org/0000-0001-9915-5122ObadićValentina5 https://orcid.org/0000-0001-9101-1570MiličićDavor28 Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia University of Zagreb, School of Medicine, Zagreb, Croatia Dubrava University Hospital, Zagreb, Croatia “Sveti Duh” University Hospital, Zagreb, Croatia “Merkur” University Hospital, Zagreb, Croatia Sisak General Hospital, Sisak, Croatia Karlovac General Hospital, Karlovac, Croatia University Hospital Centre Zagreb, Zagreb, Croatia 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 112022 17 9-10 288 289 04112022 10112022 2022 Croatian Cardiac Society KEYWORDS: earthquakecardiac emergenciesemergency department

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).

Comparison of patients examined at the emergency department prior to the earthquake and on the day or on days following the earthquake.
Total population 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 BazoukisGTseGNakaKKKalfakakouVVlachosKSaplaourasA 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. 10.1016/j.hjc.2018.05.00529807192 Seizmološka služba pri geofizièkom odsjeku PMF-a. Izvješća o potresima. [Internet]. Available from: https://www.pmf.unizg.hr/geof/seizmoloska_sluzba/izvjesca_o_potresima