Impact of severe earthquake on the occurrence of acute coronary syndrome and stroke in a rural area of Japan

Prevention of Natural Disaster-Induced Cardiovascular Diseases

Natural disasters, such as floods and landslides caused by heavy rainfall, earthquakes, and tsunamis, can induce stress, which may contribute to the onset and aggravation of various cardiovascular diseases. The circulatory system is most susceptible to the effects of stress, and stress-related cardiovascular diseases, such as Takotsubo cardiomyopathy, pulmonary thromboembolism, hypertension, stroke triggered by increased blood pressure, and acute myocardial infarction, can occur during natural disasters. The risk of developing angina pectoris, arrhythmia, sudden cardiac death, and heart failure increases rapidly and can persist for several months. Moreover, treating cardiovascular diseases is essential during the acute phase, and continuous disease management is necessary during the chronic phase. However, disaster medical care for the victims must be given priority during natural disasters, which may cause a delay in diagnosis or access to necessary treatment for pre-existing medical conditions that could worsen or may cause death in patients with cardiovascular diseases. In this review, we summarize the predisposing factors for cardiovascular diseases that have been obtained through disasters such as major earthquakes and provide potential insights to help medical staff prevent the onset and aggravation of cardiovascular diseases during disasters.

Impact of Earthquake on Cardiovascular Health: What Should Cardiovascular Healthcare Providers Anticipate After the Devastating Earthquakes in Turkey and Syria?

Natural disasters like earthquakes have direct and indirect association with major adverse cardiac events. They can impact cardiovascular health by multiple mechanisms not to mention their impact on cardiovascular care and services. Besides the humanitarian tragedy that calls attention globally, we as part of cardiovascular community are concerned with the short and long outcomes of those who survived the recent Turkey and Syria earthquake tragedy. Therefore, in this review, we aimed to draw attention of cardiovascular healthcare providers to the anticipated cardiovascular issues that may arise in survivors on short- and long-term postearthquakes to ensure proper screening and earlier management of this population. With the anticipated increase in natural disasters in future considering climate changes, geological factors, and human activities, the cardiovascular healthcare providers as part of medical community should be aware of the high rate of cardiovascular disease burden that can occur among survivors of earthquakes and other natural disasters, so, they should act accordingly in terms of preparedness measures, adequate response planning starting from services re-allocation to personnel training and enhancing access to medical and cardiac care in both acute and chronic contexts, not to mention screening and risk-stratifying the patients to optimize their management.

Major Causes of Death among Older Adults after the Great East Japan Earthquake: A Retrospective Study

This retrospective study investigated the 3-year impact of the Great East Japan Earthquake (GEJE) of 2011 on deaths due to neoplasm, heart disease, stroke, pneumonia, and senility among older adults in the primarily affected prefectures compared with other prefectures, previous investigations having been more limited as regards mortality causes and geographic areas. Using death certificates issued between 2006 and 2015 (n = 7,383,253), mortality rates (MRs) and risk ratios (RRs) were calculated using a linear mixed model with the log-transformed MR as the response variable. The model included interactions between the area category and each year of death from 2010 to 2013. The RRs in the interaction significantly increased to 1.13, 1.17, and 1.28 for deaths due to stroke, pneumonia, and senility, respectively, in Miyagi Prefecture in 2011, but did not significantly increase for any of the other areas affected by the GEJE. Moreover, increased RRs were not reported for any of the other years. The risk of death increased in 2011; however, this was only significant for single-year impact. In 2013, decreased RRs of pneumonia in the Miyagi and Iwate prefectures and of senility in Fukushima Prefecture were observed. Overall, we did not find evidence of strong associations between the GEJE and mortality.

Cardiovascular Diseases in Natural Disasters; a Systematic Review

Introduction:

As a result of destruction and lack of access to vital infrastructures and mental stress, disasters intensify cardiovascular diseases (CVDs) and hence management of CVDs becomes more challenging. The aim of this study is investigating incidence and prevalence of CVDs, morbidity and mortality of CVDs, treatment and management of CVDs at the time of natural disasters.

Methods:

In the present systematic review, the articles published in English language until 28. 11. 2020, which studied CVDs in natural disasters were included. The inclusion criteria were CVDs such as myocardial infarction (MI), acute coronary syndrome (ACS), hypertension (HTN), pulmonary edema, and heart failure (HF) in natural disasters such as earthquake, flood, storm, hurricane, cyclone, typhoon, and tornado.

Result:

The search led to accessing 4426 non-duplicate records. Finally, the data of 104 articles were included in quality appraisal. We managed to find 4, 21 and 79 full text articles, which considered cardiovascular diseases at the time of flood, storm, and earthquake, respectively.

Conclusion:

Prevalence of CVD increases after disasters. Lack of access to medication or lack of medication adjustment, losing home blood pressure monitor as a result of destruction and physical and mental stress after disasters are of the most significant challenges of controlling and managing CVDs. By means of quick establishment of health clinics, quick access to appropriate diagnosis and treatment, providing and access to medication, self-management, and self-care incentives along with appropriate medication and non-medication measures to control stress, we can better manage and control cardiovascular diseases, particularly hypertension.

Clinical characteristics of patients with ischemic stroke after the 2016 Kumamoto earthquake, a multi-center study

OBJECTIVE

To investigate the clinical characteristics of patients with ischemic stroke following the 2016 Kumamoto earthquake.

METHODS

We retrospectively studied patients with ischemic stroke admitted to 5 stroke centers for 1 year after the earthquake. We compared clinical characteristics in these patients (the post-earthquake group) to those in the patients with ischemic stroke admitted during the same period from the previous 3 years (the pre-earthquake group). Additionally, we analyzed the trend of the incidence rate of stroke before and after the earthquake.

RESULTS

A total of 1979 patients were admitted after the earthquake; 5670 (1,890/year on average) patients were admitted before the earthquake. A first-ever ischemic stroke (71 vs. 75%) and premorbid modified Rankin Scale > 1 (26 vs. 29%) were found significantly more frequently in patients after the earthquake. National Institutes of Health Stroke Scale score ≤ 2 at discharge (60 vs. 65%) was found more frequently in patients after the earthquake, although non-discharge to home (65 vs. 70%) was more frequent in patients after the earthquake. Trend analysis revealed a decrease of small vessel occlusion and large artery atherosclerosis in the month after the earthquake.

CONCLUSIONS

The 2016 Kumamoto earthquake may have affected the characteristics of stroke during the early phase of the earthquake and increased the difficulty in returning home.

Lessons learned about stress and the heart after major earthquakes

There is evidence that certain stressors can trigger cardiovascular events. Several studies have now demonstrated an increase in major adverse cardiac events associated with natural disasters such as an earthquake. The purpose of this paper is to review the literature on earthquakes and cardiovascular events. Reports from 13 major quakes were reported. Earthquakes have been associated with a number of cardiac events including sudden cardiac death, fatal myocardial infarction (MI), myocardial infarction, stress cardiomyopathy, heart failure, stroke, arrhythmias, hypertension and pulmonary embolism. Most reports were associated with earthquakes of magnitude 6.0 or greater. Cardiac events were reported within hours of the quakes. In some reports there was a sharp spike in cardiac events followed by a decrease; but in other quakes the increases in cardiac events lasted weeks, months and even years. There often was an association between the cardiac events and amount of personal property loss. The Great East Japan Earthquake was an unusual event in that it was associated with a major tsunami and cardiac events appeared worse in inundated areas due to flooding. Some but not all reports suggested more MIs associated with early morning earthquakes that woke up the population. Hospitals in earthquake-prone areas should consider developing plans for handling increases in myocardial infarctions and other cardiac events that are associated with earthquakes.

Medium- and long-term health effects of earthquakes in high-income countries: a systematic review and meta-analysis

Background

Accurate monitoring of population health is essential to ensure proper recovery after earthquakes. We aimed to summarize the findings and features of post-earthquake epidemiological studies conducted in high-income countries and to prompt the development of future surveillance plans.

Methods

Medline, Scopus and six sources of grey literature were systematically searched. Inclusion criteria were: observational study conducted in high-income countries with at least one comparison group of unexposed participants, and measurement of health outcomes at least 1 month after the earthquake.

Results

A total of 52 articles were included, assessing the effects of 13 earthquakes that occurred in eight countries. Most studies: had a time-series (33%) or cross-sectional (29%) design; included temporal comparison groups (63%); used routine data (58%); and focused on patient subgroups rather than the whole population (65%). Individuals exposed to earthquakes had: 2% higher all-cause mortality rates [95% confidence interval (CI), 1% to 3%]; 36% (95% CI, 19% to 57%) and 37% (95% CI, 29% to 46%) greater mortality rates from myocardial infarction and stroke, respectively; and 0.16 higher mean percent points of glycated haemoglobin (95% CI, 0.07% to 0.25% points). There was no evidence of earthquake effects for blood pressure, body mass index or lipid biomarkers.

Conclusions

A more regular and coordinated use of large and routinely collected datasets would benefit post-earthquake epidemiological surveillance. Whenever possible, a cohort design with geographical and temporal comparison groups should be used, and both communicable and non-communicable diseases should be assessed. Post-earthquake epidemiological surveillance should also capture the impact of seismic events on the access to and use of health care services.

Emergency radiology after a massive earthquake: clinical perspective

Earthquakes are unpredictable and inevitable disasters, causing various earthquake-related disorders. Medical imaging, including digital radiography, computed tomography, and magnetic resonance imaging, plays a key role in the evaluation of earthquake-related disorders. We here demonstrate the concept of diagnostic imaging after a massive earthquake and review the common imaging features of various disorders in casualties and evacuees. This summary of imaging features can facilitate the diagnosis of various earthquake-related disorders and promote judicious therapy planning.

Ultrasound cardiography examinations detect victims' long-term realized and potential consequences after major disasters: a case-control study

Background

An increase in cardiovascular diseases has been reported following major disasters. Previous work has shown that ultrasonographic findings from ultrasound cardiography examination (UCG) increased until the 44th month after the tsunami caused by the Great East Japan Earthquake. The present study conducted UCG among victims in the tsunami disaster area and investigated the frequency of disaster-related cardiovascular diseases and changes over time until the 55th month after the disaster.

Methods

The subjects were residents of temporary housing complexes and neighboring housing in Watari-gun, Miyagi Prefecture, Japan. There were 207 subjects in the 18th month, 125 in the 30th month, 121 in the 44th month, and 106 in the 55th month after the disaster. Data were collected through UCG and self-report questionnaire.

Results

Significant changes were observed among subjects with clinical findings from the UCG, which increased over the study period—from 42.0 to 60.8, 72.7, and 73.6% beginning in the 18th month after the disaster (p < 0.0001).

Conclusions

It is possible that the UCG can become a useful examination to visualize the potential impact of a major disaster on the cardiac function of victims. Victims with clinical findings continued increasing not only during the acute phase after a disaster but also in the long term. We therefore need to keep this in mind, and note that it is important to establish a support system to control cardiovascular diseases from the early stage of disaster.

Trial registration

UMIN; ID000029802. R000034050. 2 November 2017.

Impact of major earthquakes on the incidence of acute coronary syndromes - A systematic review of the literature

Natural disasters such as tsunami, hurricanes, and earthquakes may have a negative impact on cardiac health. The aim of our systematic review is to evaluate the impact of earthquakes on the incidence of acute coronary syndromes and cardiac mortality and to examine the impact of the time of earthquakes on the incidence of acute coronary syndromes. MEDLINE and Cochrane databases were searched for studies assessing the impact of earthquakes on acute coronary syndromes from inception until December 20, 2017. Reference lists of all included studies and relevant review studies were also searched. A total of 26 studies on 12 earthquake disasters were included in the systematic review. The existing data show a significant negative impact of the Great East Japan, Christchurch, Niigata-Chuetsu, Northridge, Great Hanshin-Awaji, Sichuan, Athens, Armenia, and Noto Peninsula earthquakes on the incidence of acute coronary syndromes. By contrast, studies on the Newcastle, Loma Prieta, and Thessaloniki earthquakes did not show a significant correlation with myocardial infarction and cardiac mortality. In conclusion, earthquakes may be associated with increased incidence of acute coronary syndromes and cardiovascular mortality. There are conflicting data about the impact of the timing of earthquakes on the occurrence of acute coronary syndromes. Preventive measures to promote the adjustment of healthcare systems to treat cardiovascular diseases after natural disasters should be immediately implemented particularly in high-risk regions.

Clinical characteristics of patients with ischemic stroke following the 2016 Kumamoto earthquake

To investigate the clinical characteristics of patients with ischemic stroke following the 2016 Kumamoto earthquake. We retrospectively studied patients with ischemic stroke admitted to our hospital for 12weeks following the earthquake. We compared the clinical backgrounds and characteristics of the patients: before (the same period from the previous 3years) and after the earthquake; and the early (first 2weeks) and late (subsequent 10weeks) phases. A total of 194 patients with ischemic stroke were admitted to our hospital after the earthquake; 496 (165.3/year) patients were admitted before the earthquake. No differences between the two groups were noted for the clinical backgrounds, characteristics, or biomarkers. Past history of sleeping in a shelter or small vehicle was found in 13% and 28% of patients, respectively. Sleeping in a shelter (27% vs. 10%, p=0.013) was found more frequently in patients during the early phase than during the late phase after the earthquake. Admission of patients with ischemic stroke increased after the earthquake; however no differences between before and after the earthquake were noted for their clinical characteristics. To prevent ischemic stroke following earthquakes, mental stress and physical status of evacuees must be assessed.

Long-term prognostic impact of the Great East Japan Earthquake in patients with cardiovascular disease - Report from the CHART-2 Study

BACKGROUND

We and others have previously reported that the Great East Japan Earthquake (GEJE) caused a significant but transient increase in cardiovascular diseases and deaths in the disaster area. However, it remains to be examined whether the GEJE had a long-term prognostic influence in large-scale cohort studies. This point is important when analyzing the data before and after the GEJE in the cohort studies in the disaster area.

METHODS

We examined 8676 patients registered in our Chronic Heart Failure Analysis and Registry in the Tohoku District-2 (CHART-2) Study (N=10,219) between 2006 and 2010 and were alive after March 10, 2011.

RESULTS

There were 48 GEJE-related deaths, causing a sharp and transient increase in all-cause death within a month after the GEJE. However, after excluding the GEJE-related deaths, the cubic polynomial spline smoothing showed no significant increase in all-cause death, heart failure admission, non-fetal acute myocardial infarction, or non-fetal stroke during the median 3-year follow-up after the GEJE. The extrapolation curves beyond the GEJE, which were obtained by the parametric survival models based on the survival data censored on the GEJE, were not significantly different from the Kaplan-Meier curves estimating the survival functions of deaths and cardiac events during the total follow-up period without considering the impacts of the GEJE. Furthermore, the multivariate Cox proportional hazard model applied to the matched cohort of the baseline data and the data after the GEJE showed no significant differences in the impacts of prognostic factors on all-cause mortality before and after the GEJE.

CONCLUSIONS

These results indicate that the GEJE had no significant long-term prognostic impact after the earthquake in cardiovascular patients in the disaster area.

Clinical characteristics of patients seizure following the 2016 Kumamoto earthquake

PURPOSE

To investigate the clinical characteristics of patients with seizure following the 2016 Kumamoto earthquake.

METHODS

We retrospectively studied patients with seizure admitted to our hospital for 12weeks following the earthquake. We compared the clinical backgrounds and characteristics of the patients: before (the same period from the previous 3years) and after the earthquake; and the early (first 2weeks) and late (subsequent 10weeks) phases.

RESULTS

A total of 60 patients with seizure were admitted to the emergency room after the earthquake, and 175 (58.3/year) patients were admitted before the earthquake. Of them, 35 patients with seizure were hospitalized in the Department of Neurology after the earthquake, and 96 (32/year) patients were hospitalized before the earthquake. In patients after the earthquake, males and non-cerebrovascular diseases as an epileptogenic disease were seen more frequently than before the earthquake. During the early phase after the earthquake, female, first-attack, and non-focal-type patients were seen more frequently than during the late phase after the earthquake.

CONCLUSIONS

These characteristics of patients with seizure during the early phase after the earthquake suggest that many patients had non-epileptic seizures. To prevent seizures following earthquakes, mental stress and physical status of evacuees must be assessed.

Predictors of Hypertension in Survivors of the Great East Japan Earthquake, 2011: A Cross-sectional Study

Introduction

Many survivors of a major disaster die shortly after the event. Hypertension (HT) is one of the most important risk factors for these disaster-related diseases. An urgent need exists to establish methods to detect disaster survivors with HT and start medication immediately, as those with no injuries or symptoms may not be examined and medical teams cannot measure all survivors’ blood pressure (BP) because they often do not have sufficient time.

Objective

The goals of this report were: (1) to evaluate the importance of taking antihypertensive drugs continuously for patients with HT during the sub-acute phase after a major earthquake, when patients cannot attend a clinic because of destruction of the local infrastructure; and (2) to establish simple and reliable predictors to detect evacuees with HT, who require clinical examination and treatment at evacuation shelters or in their homes after a major earthquake.

Methods

Medical rounds were performed at evacuation shelters in Iwate Prefecture after the Great East Japan Earthquake. Forty evacuees were enrolled in a cross-sectional study. The effect of taking antihypertensive drugs continuously was evaluated and predictors of HT in evacuees were identified using multiple logistic regression analysis.

Results

Twenty-eight evacuees were hypertensive (70%), nine of whom were asymptomatic (32%). Most evacuees who had discontinued antihypertensive medication (92%; 11/12) had very high BP, while those who had continued antihypertensive medication (80%; 8/10) were mildly hypertensive. The systolic BP of those who had discontinued antihypertensive drugs was significantly higher than that of those who had continued hypertensive drugs in the whole cohort (n=40), and also in evacuees diagnosed as having HT at evacuation shelters (n=28; P<.01 for both comparisons). A history of HT (adjusted odds ratio [aOR], 11.40; 95% confidence interval [CI], 1.03-126.08) or age >55 years (aOR, 1.10; 95% CI, 1.01-1.21) predicted HT with a sensitivity of 0.96 and specificity of 0.80.

Conclusions

The results of this study suggest that continuity of antihypertensive medication prevents serious HT at evacuation shelters in the first 10 days after a major earthquake. Onsite medical rounds focusing on simple predictors in an early stage after disasters may be an effective means of detecting and treating hypertensive disaster victims before they succumb to a fatal disease.

TanakaR, OkawaM, UjikeY. Predictors of hypertension in survivors of the Great East Japan Earthquake, 2011: a cross-sectional study. Prehosp Disaster Med. 2016;31(1):17–26.

Comparison of cardiovascular mortality in the Great East Japan and the Great Hanshin-Awaji Earthquakes - a large-scale data analysis of death certificates

BACKGROUND

Large earthquakes have been associated with cardiovascular disease (CVD) mortality. In Japan, the 1995 Great Hanshin-Awaji (H-A) Earthquake was an urban-underground-type earthquake, whereas the 2011 Great East Japan (GEJ) Earthquake was an ocean-trench type. In the present study, we examined how these different earthquake types affected CVD mortality.

METHODS AND RESULTS

We examined death certificate data from 2008 to 2012 for 131 municipalities in Iwate, Miyagi, and Fukushima prefectures (n=320,348) and from 1992 to 1996 for 220 municipalities in Hyogo, Osaka, and Kyoto prefectures (n=592,670). A Poisson regression model showed significant increases in the monthly numbers of acute myocardial infarction (AMI)-related deaths (incident rate ratio [IRR] GEJ=1.34, P=0.001; IRR of H-A=1.57, P<0.001) and stroke-related deaths (IRR of GEJ=1.42, P<0.001; IRR of H-A=1.33, P<0.001) after the earthquakes. Two months after the earthquakes, AMI deaths remained significant only for H-A (IRR=1.13, P=0.029). When analyzing the standardized mortality ratio (SMR) after the earthquakes using the Cochran-Armitage trend test, seismic intensity was significantly associated with AMI mortality for 2 weeks after both the GEJ (P for trend=0.089) and H-A earthquakes (P for trend=0.005).

CONCLUSIONS

Following the GEJ and H-A earthquakes, there was a sharp increase in CVD mortality. The effect of the disaster was sustained for months after the H-A earthquake, but was diminished after the GEJ Earthquake.

Changes in Hospitalization for Ischemic Heart Disease After the 2008 Sichuan Earthquake: 10 Years of Data in a Population of 300,000

OBJECTIVE

The effects of earthquakes on ischemic heart disease (IHD) have often been reported. At a population level, this study examined short-term (60-day) and long-term (5-year) hospitalization events for IHD after the 2008 Sichuan earthquake.

METHODS

We examined the 10-year medical hospitalization records on IHD in the city of Deyang provided by the Urban Employee Basic Health Insurance program.

RESULTS

Evaluation of 19,083 hospitalizations showed a significantly lower proportional number and cost of hospitalizations in the 60 days after the earthquake (P<0.001). Hospitalizations were 27.81% lower than would have been expected in a normal year; costs were 32.53% lower. However, in the 5 years after the earthquake, the age-adjusted annual incidence of hospitalization increased significantly (P<0.001). In the fifth year after the earthquake, it was significantly higher in the extremely hard-hit area than in the hard-hit area (P<0.01).

CONCLUSION

After the 2008 earthquake, short- and long-term patterns of hospitalization for IHD changed greatly, but in different ways. Our findings suggest that medical resources for IHD should be distributed dynamically over time after an earthquake.

Burden of cardiovascular morbidity and mortality following humanitarian emergencies: a systematic literature review

BACKGROUND

The global burden of cardiovascular mortality is increasing, as is the number of large-scale humanitarian emergencies. The interaction between these phenomena is not well understood. This review aims to clarify the relationship between humanitarian emergencies and cardiovascular morbidity and mortality.

METHODS

With assistance from a research librarian, electronic databases (PubMed, Scopus, CINAHL, and Global Health) were searched in January 2014. Findings were supplemented by reviewing citations of included trials. Observational studies reporting the effect of natural disasters and conflict events on cardiovascular morbidity and mortality in adults since 1997 were included. Studies without a comparison group were not included. Double-data extraction was utilized to abstract information on acute coronary syndrome (ACS), acute decompensated heart failure (ADHF), and sudden cardiac death (SCD). Review Manager 5.0 (Version 5.2, The Nordic Cochrane Centre; Copenhagen Denmark,) was used to create figures for qualitative synthesis.

RESULTS

The search retrieved 1,697 unique records; 24 studies were included (17 studies of natural disasters and seven studies of conflict). These studies involved 14,583 cardiac events. All studies utilized retrospective designs: four were population-based, 15 were single-center, and five were multicenter studies. Twenty-three studies utilized historical controls in the primary analysis, and one utilized primarily geographical controls.

DISCUSSION

Conflicts are associated with an increase in long-term morbidity from ACS; the short-term effects of conflict vary by study. Natural disasters exhibit heterogeneous effects, including increased occurrence of ACS, ADHF, and SCD.

CONCLUSIONS

In certain settings, humanitarian emergencies are associated with increased cardiac morbidity and mortality that may persist for years following the event. Humanitarian aid organizations should consider morbidity from noncommunicable disease when planning relief and recuperation projects.

Heart attacks triggered by huge mud slides in mountain regions and severe flooding in inhabited areas

BACKGROUND

On July 12, 2012, heavy rains struck southwest Japan, particularly in the Mount Aso area. Huge mud slides in the mountains destroyed houses, and heavy rains caused severe flooding in the inhabited areas. We investigated the incidence of cardiovascular events after the disaster.

METHODS

We investigated patients who were admitted to the emergency department (ED) from July 12 to August 31 in 2012. We reviewed all patients with cardiovascular events, including acute myocardial infarction (AMI), angina attack, worsening of congestive heart failure (CHF), cardiopulmonary arrest (CPA), arrhythmias, tako-tsubo cardiomyopathy (TC), and symptomatic venous thromboembolism (VTE).

RESULTS

The total number of cardiovascular events was 28 (14 supraventricular arrhythmias, 3 angina attacks, 1 AMI, 1 VTE, 4 CHF, 1 TC and 4 CPA). There was a significant increase in cardiovascular events during the follow-up period in 2012 in comparison with the average number of these events over the same time period during the prior 2 years (16.8 vs. 5.1/month, p<0.01). There was a sharp increase in cardiovascular events in the first week after the disaster. A second peak was observed 7 weeks after the disaster. Two patients with angina attack were previously diagnosed as having vasospastic angina. The incidence rate of AMI did not increase.

CONCLUSION

An increase in cardiovascular events was observed after severe rainfalls and mud slides. Prevention of disaster-induced cardiovascular events should be a priority regardless of the magnitude of the disaster.

Clinical features of patients with decompensated heart failure after the Great East Japan Earthquake

The occurrence of heart failure (HF) and its clinical features after a great disaster have not been rigorously examined. We retrospectively examined the effect of the Great East Japan Earthquake on the occurrence of decompensated HF. The number of patients admitted for treatment of decompensated HF and their clinical features were compared between 2 periods, March 11, 2011 to September 10, 2011 (after the earthquake) and the same period in the previous year. The number of admissions increased from 55 in 2010 to 84 in 2011. A comparison of the clinical features showed that the patients admitted after the earthquake had (1) older age (p = 0.031), (2) greater systolic blood pressure (p = 0.039), (3) a greater incidence of new-onset HF due to valvular heart disease (p = 0.040), (4) interruption of drugs (p = 0.001), (5) a greater incidence of infection (p = 0.019), (6) greater B-type natriuretic peptide (p = 0.005) and C-reactive protein (p = 0.003) levels, (7) a lower estimated glomerular filtration rate (p = 0.048) and lower albumin levels (p = 0.021), and (8) a larger diameter of the inferior vena cava (p = 0.008). In conclusion, these results suggest that the earthquake increased the incidence of HF in association with high blood pressure, interruption of drugs, inflammation, malnutrition, and fluid retention. Taking appropriate measures to control blood pressure, nutritional status, and hygiene environment might decrease the occurrence of HF in future disasters.

Disease pattern and chronic illness in rural China: the Hong Kong Red Cross basic health clinic after 2008 Sichuan earthquake

BACKGROUND

Medical teams might have difficulties preparing for deployment to rural towns due to a lack of prior information. The study objective was to identify the health needs and chronic disease prevalence of rural Chinese following a major earthquake.

METHODS

Hong Kong Red Cross organised a basic healthcare team to Yanmen town, Jiangyou 3 weeks after the 2008 Sichuan earthquake. A cross-sectional records-based study of all patients treated by the Hong Kong Red Cross basic healthcare team from 1 June to 19 June 2008 was conducted.

RESULTS

Two thousand and thirty-four individual patient encounters occurred during the 19-day period. Musculoskeletal, respiratory and gastrointestinal problems were the top three categories and accounted for 30.4%, 17.4% and 12.7%, respectively. The 43.4% of the 762 patients with blood pressure measurements were above the recognised criteria for hypertension.

CONCLUSIONS

We identified that the management of chronic diseases was an important issue, especially with the high prevalence of hypertension found in our study. Medical responders need to be aware of the potential pre-existing disease burden in the community, with the possible exacerbation in post-disaster situations. Careful planning on the use of treatment guidelines with particular focus on the local health resources available and issues with continuation of care will provide better care for the patients.

Influence of the great East Japan earthquake and tsunami 2011 on occurrence of cerebrovascular diseases in Iwate, Japan

BACKGROUND AND PURPOSE

Little information is available regarding the occurrence of cerebrovascular diseases after tsunamis. This study was performed to determine the influence of the tsunami damage caused by the Great East Japan earthquake on occurrence of cerebrovascular diseases.

METHODS

Subjects from the coastline and inland areas of Iwate Prefecture who developed cerebrovascular diseases before and after the disaster were included in the analysis. Standardized incidence ratios of 2011 against the previous 3 years were calculated in two 4-week periods before and four 4-week periods after the disaster, according to stroke subtype, sex, age group, and flood damage.

RESULTS

The standard incidence ratio for cerebrovascular diseases was 1.20 (1.00-1.40) in the first 4-week period after the disaster and was not significant in other periods. The standard incidence ratios in the first 4-week period for cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage were 1.22 (0.98-1.46), 1.15 (0.76-1.55), and 1.20 (0.52-1.88), respectively. These values were 1.51 (1.19-1.88) for men, 1.35 (1.06-1.64) for subjects aged ≥ 75 years, and 1.35 (1.06-1.64) for the high flooding areas. The standard incidence ratio of cerebral infarction in the first 4-week period for men aged ≥ 75 years in the high flooding areas was 2.34 (1.34-3.34).

CONCLUSIONS

In the areas highly flooded by the tsunami caused by the Great East Japan earthquake, the occurrence of cerebral infarction among elderly men more than doubled in the first 4 weeks after the disaster.

Long-term blood pressure changes induced by the 2009 L'Aquila earthquake: assessment by 24 h ambulatory monitoring

An increased rate of cardiovascular and cerebrovascular events has been described during and immediately after earthquakes. In this regard, few data are available on long-term blood pressure control in hypertensive outpatients after an earthquake. We evaluated the long-term effects of the April 2009 L'Aquila earthquake on blood pressure levels, as detected by 24 h ambulatory blood pressure monitoring. Before/after (mean±s.d. 6.9±4.5/14.2±5.1 months, respectively) the earthquake, the available 24 h ambulatory blood pressure monitoring data for the same patients were extracted from our database. Quake-related daily life discomforts were evaluated through interviews. We enrolled 47 patients (25 female, age 52±14 years), divided into three groups according to antihypertensive therapy changes after versus before the earthquake: unchanged therapy (n=24), increased therapy (n=17) and reduced therapy (n=6). Compared with before the quake, in the unchanged therapy group marked increases in 24 h (P=0.004), daytime (P=0.01) and nighttime (P=0.02) systolic blood pressure were observed after the quake. Corresponding changes in 24 h (P=0.005), daytime (P=0.01) and nighttime (P=0.009) diastolic blood pressure were observed. Daily life discomforts were reported more frequently in the unchanged therapy and increased therapy groups than the reduced therapy group (P=0.025 and P=0.018, respectively). In conclusion, this study shows that patients with unchanged therapy display marked blood pressure increments up to more than 1 year after an earthquake, as well as long-term quake-related discomfort. Our data suggest that particular attention to blood pressure levels and adequate therapy modifications should be considered after an earthquake, not only early after the event but also months later.

Electrocardiographic features of patients with earthquake related posttraumatic stress disorder

AIM: To analyze electrocardiographic features of patients diagnosed with posttraumatic stress disorder (PTSD) after the Van-Erciş earthquake, with a shock measuring 7.2 on the Richter scale that took place in Turkey in October 2011.

METHODS: Surface electrocardiograms of 12 patients with PTSD admitted to Van Erciş State Hospital (Van, Turkey) from February 2012 to May 2012 were examined. Psychiatric interviews of the sex and age matched control subjects, who had experienced the earthquake, confirmed the absence of any known diagnosable psychiatric conditions in the control group.

RESULTS: A wide range of electrocardiogram (ECG) parameters, such as P-wave dispersion, QT dispersion, QT interval, Tpeak to Tend interval, intrinsicoid deflection durations and other traditional parameters were similar in both groups. There was no one with an abnormal P wave axis, short or long PR interval, long or short QT interval, negative T wave in lateral leads, abnormal T wave axis, abnormal left or right intrinsicoid deflection duration, low voltage, left bundle branch block, right bundle branch block, left posterior hemiblock, left or right axis deviation, left ventricular hypertrophy, right or left atrial enlargement and pathological q(Q) wave in either group.

CONCLUSION: The study showed no direct effect of earthquake related PTSD on surface ECG in young patients. So, we propose that PTSD has no direct effect on surface ECG but may cause electrocardiographic changes indirectly by triggering atherosclerosis and/or contributing to the ongoing atherosclerotic process.

The Great East Japan Earthquake Disaster and cardiovascular diseases

AIMS

While previous studies reported a short-term increase in individual cardiovascular disease (CVD) after great earthquakes, mid-term occurrences of all types of CVDs after great earthquakes are unknown. We addressed this important issue in our experience with the Great East Japan Earthquake (11 March 2011).

METHODS AND RESULTS

We retrospectively examined the impact of the Earthquake on the occurrences of CVDs and pneumonia by comparing the ambulance records made by doctors in our Miyagi Prefecture, the centre of the disaster area, during the periods of 2008-11 (n = 124,152). The weekly occurrences of CVDs, including heart failure (HF), acute coronary syndrome (ACS), stroke, cardiopulmonary arrest (CPA), and pneumonia were all significantly increased after the Earthquake compared with the previous 3 years. The occurrences of ACS and CPA showed the rapid increase followed by a sharp decline, whereas those of HF and pneumonia showed a prolonged increase for more than 6 weeks and those of stroke and CPA showed a second peak after the largest aftershock (7 April 2011). Furthermore, the occurrence of CPA was increased in the first 24 h after the Earthquake, followed by other diseases later on. These increases were independent of age, sex, or residence area (seacoast vs. inland).

CONCLUSION

These results indicate that the occurrences of all types of CVDs and pneumonia were increased in somewhat different time courses after the Earthquake, including the first observation of the marked and prolonged increase in HF, emphasizing the importance of intensive medical management of all types of CVDs after great earthquakes.

Cardiovascular and cerebrovascular events pre- and post-earthquake of 6 April 2009: the Abruzzo's experience

BACKGROUND

On 6 April 2009, an earthquake occurred in Abruzzo, a small region in the middle-east of Italy. Its chief town, L'Aquila, was the epicenter. We carried out an observational analysis to evaluate the potential association between the earthquake and the rate of cardiovascular and cerebrovascular admissions of the residents in the province of L'Aquila.

METHODS

We used administrative discharge data, extracting all admissions made from 6 April to 31 July 2008 (pre-earthquake control period) or from 6 April to 31 July 2009 (post-earthquake period), assigned to diagnosis-related groups (DRGs) related to cardiovascular or cerebrovascular diseases.

RESULTS

The overall number of hospitalizations for cardio- or cerebrovascular diseases by residents in L'Aquila before and after the earthquake was 10,833. In the whole region, the hospitalization rate was slightly lower in 2009 (-0.9%), whereas only in the local health unit (LHU) of L'Aquila it showed an increase by +13.2% (P < 0.01), essentially due to cardiovascular diseases (+21.9%) in elderly people (+26.9%; P < 0.01). The proportion of the main comorbidities in the admissions for cardiovascular diseases of the residents in L'Aquila significantly increased (P = 0.03), but no significant differences could be observed for each comorbidity separately.

CONCLUSIONS

Our study supports previous findings of an association between earthquakes and an increase in cardiovascular diseases in the elderly.

[Cardiologic emergencies and natural disaster. Prospective study with Xynthia tempest]

BACKGROUND

Stress-induced cardiomyopathy and ischemic cardiopathy have been described after natural disasters such as earthquakes.

OBJECTIVES OF THE STUDY

Count stress-induced cardiomyopathies and ischemic cardiopathies just after Xynthia tempest which damaged the Vendean coast on February2010, in order to study epidemiology.

PATIENTS AND METHOD

Included patients were living in a tempest damaged village, and admitted in Vendee hospital just after or in the week following the tempest, and presenting a suspected acute coronary syndrome or stress-induced cardiomyopathy.

RESULTS

Among 3350 inhabitants of the two damaged Vendean towns, we count three acute coronary syndromes, two Tako-Tsubo cardiomyopathies, and one coronary spasm. We count five women and one man, average age is 76.

CONCLUSION

The diagnosis of ischemic cardiopathy and stress-induced cardiomyopathy is over-represented in this tempest damaged population, that have been little described.

Vasculopathic cranial ocular motor neuropathy following sudden emotional stress

We describe three patients who experienced onset of a microvascular ocular motor nerve palsy in the setting of sudden emotional stress. Such emotional states are accompanied by a marked increase in sympathetic tone in some individuals. Mechanisms by which these autonomic changes might produce an ischemic cranial nerve palsy include intra-cranial vasoconstriction and transient systemic hypotension due to alterations in cardiac function.

Neurological disorders in complex humanitarian emergencies and natural disasters

Complex humanitarian emergencies include the relatively acute, severe, and overwhelming health consequences of armed conflict, food scarcity, mass displacement, and political strife. Neurological manifestations of complex humanitarian emergencies are important and underappreciated consequences of emergencies in populations worldwide. This review critically assesses the existing knowledge of the range of neurological disorders that accompany complex humanitarian emergencies and natural disasters in both the acute phase of crisis and the "long shadow" that follows.

Connexin-43 redistribution and gap junction activation during forced restraint protects against sudden arrhythmic death in rats

BACKGROUND

Connexin-43 (Cx43) expression is reduced or redistributed in heart disease. Restraint or other emotional stressors might cause sudden death in persons with such diseases, but the mechanism of death and its connection to Cx43 during restraint remain unknown. Whether Cx43 distribution or gap junction (GJ) function during restraint is involved in sudden arrhythmic death in rats is addressed in this study.

METHODS AND RESULTS

Male Sprague-Dawley rats underwent immobilization (IMO), and individual electrocardiographic responses were monitored by telemetry. Heart sections were used to examine ventricular Cx43 distribution, and GJ intercellular communication (GJIC) activity was assessed using a dye-transfer assay. IMO induced the translocation of Cx43 into to the GJ-rich fraction, with a peak at 60 min. During IMO, Cx43 immunofluorescence was enhanced at intercalated discs, in association with GJIC activation, and premature ventricular contractions (PVCs) increased. In the presence of the GJ inhibitor, carbenoxolone (0.25 mg.kg(-1).h(-1)), IMO induced lethal ventricular tachycardia or fibrillation in 21.7% of rats, in association with QRS prolongation and increased PVCs.

CONCLUSIONS

IMO causes Cx43 translocation to intercalated discs, thereby reducing vulnerability to lethal arrhythmias via enhancing GJ coupling.