Contrast Stress Echocardiography for the Diagnosis of Coronary Artery Disease in Patients With Chest Pain but Without Acute Coronary Syndrome: Incremental Value of Myocardial Perfusion

Abstract Background Traditional coronary artery disease risk factors are well established and help risk stratify most patients presenting with chest pain syndromes. Young patients (under age 30 years) without other risk factors are thought to be at very low risk of coronary artery disease and acute coronary syndromes. Case presentation We highlight the case of a 27-year-old Afro-Caribbean male who presented to hospital with chest pain and was discharged from the emergency room because he was thought to be low risk for ischemic heart disease. Laboratory investigations subsequently confirmed acute coronary syndrome. He was found to have an anomalous right coronary artery with a malignant origin running between the aorta and pulmonary artery eventually requiring surgical correction. Anomalous origins of the coronary arteries are rare causes of acute coronary syndromes, chest pain, and sudden cardiac death. Conclusion Our patient could have easily had an adverse outcome as his diagnosis was missed by the initial treating physician. It is important to consider anomalous coronary artery origin in the evaluation of young symptomatic patients who may be otherwise low risk and not have traditional risk factors for ischemic heart disease.

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Presence and Extent of Coronary Artery Disease by Cardiac Computed Tomography and Risk for Acute Coronary Syndrome in Cocaine Users Among Patients With Chest Pain

The American Journal of Cardiology ◽

10.1016/j.amjcard.2008.11.011 ◽

2009 ◽

Vol 103 (5) ◽

pp. 620-625 ◽

Cited By ~ 13

Author(s):

Fabian Bamberg ◽

Christopher L. Schlett ◽

Quynh A. Truong ◽

Ian S. Rogers ◽

Wolfgang Koenig ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery Disease ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Coronary Artery ◽

Cardiac Computed Tomography ◽

Coronary Syndrome ◽

Cocaine Users ◽

Artery Disease

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Abstract 18648: Suspected Acute Coronary Syndrome With Normal Coronary Arteries: The Value of Cardiac Magnetic Resonance in Changes of Treatment

Circulation ◽

10.1161/circ.132.suppl_3.18648 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Alexandre M Soeiro ◽

Débora Y Nakamura ◽

Tatiana C Leal ◽

Aline S Bossa ◽

Maria C Soeiro ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Coronary Artery ◽

Obstructive Coronary Artery Disease ◽

Final Diagnosis ◽

Gadolinium Enhancement ◽

Coronary Syndrome ◽

Artery Disease

Introduction: Acute chest pain, ST-changes on EKG and elevation of cardiac troponin in patients without obstructive coronary artery disease represent a clinical challenge. Cardiovascular magnetic resonance (CMR) can be used to diagnose causes other than obstructive coronary artery disease. Hypothesis: The aim of this study was to evaluate the usefulness of CMR to diagnose conditions in the emergency room that otherwise would be considered as acute coronary syndrome (ACS) in patients with normal coronary arteries. Methods: Fifty-nine patients with chest pain and/or electrocardiographic changes and elevated troponin concentration occurring in the absence of significant coronary artery stenosis (normal or stenosis < 50% of the vessel diameter on angiography, computed tomography or both) were selected and prospectively submitted to CMR exam in a 1.5T Philips scanner between May 2013 and December 2014. Ventricular function by cine MR with SSFP technique, and myocardial tissue characterization using late gadolinium enhancement (LGE) were evaluated in patients referred to the Emergency room. LGE patterns were analyzed visually by 2 observers and classified as ischemic (involving subendocardial layer) and nonischemic (multifocal, not involving subendocardial layer, non coronary distribution). Results: Among 59 patients, all with interpretable CMR exams, diagnosis of acute myocarditis was found in 39% of patients, acute myocardial infarction in 17% and Takotsubo cardiomyopathy in 12%. Other final diagnoses were hypertrophic cardiomyopathy (5%), coronary embolism (10%), cardiomyopathy (3%), sepsis (4%), aortic stenosis (3%) and non-compaction myocardium (2%). In 38 patients (66%), CMR changed the initial ACS diagnosis to another final diagnosis. Additionally,3 patients primarily considered as having myocarditis received a final diagnosis of myocardial infarction. Conclusions: In the study, 66% of patients had their primary diagnosis and treatment changed after CMR study. The presence, distribution and pattern of late gadolinium enhancement by CMR were crucial in establishing a precise final diagnosis and appropriately changing patient management.

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Utility of Physician Selection of Cardiac Tests in a Chest Pain Unit to Exclude Acute Coronary Syndrome Among Patients Without a History of Coronary Artery Disease

The American Journal of Cardiology ◽

10.1016/j.amjcard.2017.12.030 ◽

2018 ◽

Vol 121 (7) ◽

pp. 825-829 ◽

Cited By ~ 5

Author(s):

Stacey J. Howell ◽

Jonathan Bui ◽

Balasingam Thevakumar ◽

Ezra A. Amsterdam

Keyword(s):

Coronary Artery Disease ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Coronary Artery ◽

Chest Pain Unit ◽

Coronary Syndrome ◽

History Of ◽

Artery Disease ◽

Selection Of

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Family history of coronary artery disease is associated with acute coronary syndrome in 28,188 chest pain patients

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872619853521 ◽

2019 ◽

Vol 9 (7) ◽

pp. 741-747 ◽

Cited By ~ 1

Author(s):

Agnes Wahrenberg ◽

Patrik KE Magnusson ◽

Andrea Discacciati ◽

Lina Ljung ◽

Tomas Jernberg ◽

...

Keyword(s):

Coronary Artery Disease ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Coronary Artery ◽

Family History ◽

Young Patients ◽

Coronary Syndrome ◽

History Of ◽

Artery Disease ◽

Pain Patients

Background: The value of family history of coronary artery disease (CAD) in diagnosing acute coronary syndrome (ACS) in chest pain patients is uncertain, especially in relation to high-sensitivity assays for cardiac troponin T (hs-cTnT), which have improved ACS diagnostics. Our objective was to investigate the association between verified family history of CAD and ACS in chest pain patients, overall and in different strata of initial hs-cTnT. Methods: Data on chest pain patients visiting four emergency departments in Sweden during 2013–2016 were cross-referenced with national registers of kinship, diseases and prescriptions. Family history of early CAD was defined as the occurrence of myocardial infarction or coronary revascularization before the age of 55 years in male and 65 years in female first-degree relatives. The outcome was combined including ACS and cardiovascular death within 30 days of presentation. Results: Of 28,188 patients, 4.7% of patients had ACS. In total, 8.2% and 32.4% had a family history of early and ever-occurring CAD, respectively. Family history of CAD was positively associated with the outcome, independently of age, gender, cardiovascular risk factors and electrocardiogram findings. The strongest association was observed for family history of early CAD (odds ratio 1.62, 95% confidence interval 1.35–1.94). Stronger associations were observed in young patients (e.g. <65 years) and in patients with non-elevated initial hs-cTnT levels ( p-value for interaction = 0.004 and 0.001, respectively). Conclusions: Family history of CAD is associated with ACS in chest pain patients, especially in patients of young age or with non-elevated initial hs-cTnT levels.

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