Typical chest pain and onset of acute myocardial infarction in a prospective cohort of emergency calls

Abstract Background: As a true endocrine emergency, thyroid storm is rarely associated with acute myocardial infarction. However Graves’ disease is the most common underlying cause of thyroid storm. Clinical Case: A 47-year women experienced typical chest pain since 30 minutes before visited emergency room. The patient had type two diabetes as a cardiovascular risk factor and regularly took metformin thrice daily. The electrocardiogram showed non-ST segment elevation in leads I, V4-V6. Coronary arteriography showed stenosis in the three and left main vessels (70% stenosis of right coronary, 80% stenosis of left circumflex, 90% stenosis of left anterior descendent, and 90% stenosis of mid distal, in left main stem) then the patient was planned to do bypass surgery. At day 6 of hospitalization, the typical chest pain was worsening, epigastric pain became more painful, had 5 times diarrhea per day, high grade fever (>38.5oC), severe nausea and vomiting, then generalized tonic clonic seizure and respiratory failure was occurred. The patient was intubated in intensive care unit. Through a detail physical examination, a diffuse palpable thyroid enlargement and class I ophthalmopathy were found. Laboratory findings of free T4 was 2.23 ng/dL and Thyroid Stimulating Hormone (TSH) was 0.003 µIU/mL. The patient was assessed as thyroid storm then immediately, treated with three times of 100 mg hydrocortisone, two times of 20 mg of propranolol, and three times of 400 mg propylthiourasil. The patient’s clinical appearance was gradually recovered. After 3 days of treatment, she was extubated from ventilator. Two weeks later, no complaint of chest pain or epigastric pain in observation. Conclusion: Our case highlight the possibility that hyperthyroidism may be involved in the development of acute myocardial infarction.

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Typical chest pain and precordial leads ST-elevation in patients with pacemakers - are we always looking at an acute myocardial infarction?

Vojnosanitetski pregled ◽

10.2298/vsp130916061o ◽

2015 ◽

Vol 72 (9) ◽

pp. 837-840

Author(s):

Marina Ostojic ◽

Tatjana Potpara ◽

Marija Polovina ◽

Mladen Ostojic ◽

Miodrag Ostojic

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Emergency Department ◽

Case Report ◽

Chest Pain ◽

Pacemaker Implantation ◽

Ecg Changes ◽

St Segment Elevation ◽

St Segment ◽

Typical Chest Pain

Introduction. Electrocardiographic (ECG) diagnosis of acute myocardial infarction (AMI) in patients with paced rhythm is difficult. Sgarbossa?s criteria represent helpful diagnostic ECG tool. Case report. A 57-year-old female patient with paroxysmal atrial fibrillation and a permanent pacemaker presented in the Emergency Department with prolonged typical chest pain and ECG recording suggestive for AMI. Documented ECG changes correspond to the first Sgarbossa?s criterion for AMI in patients with dual pacemakers (ST-segment elevation of ? 5 mm in the presence of the negative QRS complex). The patient was sent to catheterization lab where coronary angiogram reveled normal findings. ECG changes occurred due to pericardial reaction following two interventions: pacemaker implantation a month before and radiofrequency catheter ablation of AV junction two weeks before presentation in Emergency Department. Conclusion. This case report points out to the limitations of proposed criteria that aid in the recognition of AMI in patients with underlying paced rhythm and possible cause(s) of transient electrocardiographic abnormalities.

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Successful Percutaneous Intervention to Acute Myocardial Infarction Presenting With Typical Chest Pain in Transplanted Heart

Circulation Journal ◽

10.1253/circj.cj-08-0222 ◽

2009 ◽

Vol 73 (11) ◽

pp. 2166-2168 ◽

Cited By ~ 2

Author(s):

Ulas Bildirici ◽

Umut Celikyurt ◽

Ertan Ural ◽

Tayfun Sahin ◽

Ahmet Vural ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Chest Pain ◽

Percutaneous Intervention ◽

Typical Chest Pain

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Faculty Opinions recommendation of Gender differences in all-cause, cardiovascular and cancer mortality during long-term follow-up after acute myocardial infarction; a prospective cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727409677.793552943 ◽

2018 ◽

Author(s):

Nanette Wenger ◽

Tina Varghese

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Gender Differences ◽

Cohort Study ◽

Prospective Cohort Study ◽

Cancer Mortality ◽

Prospective Cohort ◽

Long Term Follow Up

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Diagnostic markers for discriminating between acute aortic dissection and acute myocardial infarction during the pre-hospital phase: analysis of 3,195 cases

European Heart Journal ◽

10.1093/ehjci/ehaa946.2326 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Watanabe ◽

H Yoshino ◽

T Takahashi ◽

M Usui ◽

K Akutsu ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Back Pain ◽

Chest Pain ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Diagnostic Markers ◽

Network Database ◽

History Of ◽

First Contact

Abstract Both acute aortic dissection (AAD) and acute myocardial infarction (AMI) present with chest pain and are life-threatening diseases that require early diagnosis and treatment for better clinical outcome. However, two critical diseases in the very acute phase are sometimes difficult to differentiate, especially prior to arrival at the hospital for urgent diagnosis and selection of specific treatment. The aim of our study was to clarify the diagnostic markers acquired from the information gathered from medical history taking and physical examination for discriminating AAD from AMI by using data from the Tokyo Cardiovascular Care Unit (CCU) Network database. We examined the clinical features and laboratory data of patients with AAD and AMI who were admitted to the hospital in Tokyo between January 2013 and December 2015 by using the Tokyo CCU Network database. The Tokyo CCU Network consists of >60 hospitals that fulfil certain clinical criteria and receive patients from ambulance units coordinated by the Tokyo Fire Department. Of 15,061 patients diagnosed as having AAD and AMI, 3,195 with chest pain within 2 hours after symptom onset (537 AAD and 2,658 AMI) were examined. The patients with out-of-hospital cardiac arrest were excluded. We compared the clinical data of the patients with chest pain who were diagnosed as having AAD and AMI. The following indicators were more frequent or had higher values among those with AAD: female sex (38% vs. 20%, P<0.001), systolic blood pressures (SBPs) at the time of first contact by the emergency crew (142 mmHg vs. 127 mmHg), back pain in addition to chest pain (54% vs. 5%, P<0.001), history of hypertension (73% vs. 58%, P<0.001), SBP ≥150 mmHg (39% vs. 22%, P<0.001), back pain combined with SBP ≥150 mmHg (23% vs. 0.8%, P<0.001), and back pain with SBP <90 mmHg (4.5% vs. 0.1%, P<0.001). The following data were less frequently observed among those with AAD: diabetes mellitus (7% vs. 28%, P<0.001), dyslipidaemia (17% vs. 42%, P<0.001), and history of smoking (48% vs. 61%, P<0.001). The multivariate regression analysis suggested that back pain with SBP ≥150 mmHg (odds ratio [OR] 47; 95% confidence interval [CI] 28–77; P<0.001), back pain with SBP <90 mmHg (OR 68, 95% CI 16–297, P<0.001), and history of smoking (OR 0.49, 95% CI 0.38–0.63, P<0.001) were the independent markers of AAD. The sensitivity and specificity of back pain with SBPs of ≥150 mmHg and back pain with SBPs <90 mmHg for detecting AAD were 23% and 99%, and 4% and 99%, respectively. In patients with chest pain suspicious of AAD and AMI, “back pain accompanied by chest pain with SBP ≥150 mmHg” or “back pain accompanied by chest pain with SBP <90 mmH” is a reliable diagnostic marker of AAD with high specificity, although the sensitivity was low. The two SBP values with back pain are markers that may be useful for the ambulance crew at their first contact with patients with chest pain. Funding Acknowledgement Type of funding source: None

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Heparin Neutralizing Activity in the Diagnosis of Acute Myocardial Infarction

10.1055/s-0039-1689202 ◽

1975 ◽

Author(s):

J. R. O’Brien ◽

M. D. Etherington ◽

S. Jamieson ◽

J. Sussex

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Chest Pain ◽

Acute Chest Pain ◽

Platelet Factor 4 ◽

Clotting Time ◽

Platelet Factor ◽

Neutralizing Activity ◽

Platelet Poor Plasma ◽

Activated Platelets

We have previously demonstrated that, relative to controls, patients long after myocardial infarction and patients with atherosclerosis have highly significantly shorter heparin thrombin clotting times (HTCT) using platelet poor plasma; but there was considerable overlap between the two groups.We have now studied 89 patients admitted with acute chest pain. In 54 of these a firm diagnosis of acute myocardial infarction (ac-MI) was made and the HTCT was very short (mean 12.8 sees) and in 48 it was less than 16 sees. In 34 patients, ac-MI was excluded and the diagnosis was usually “angina”; the HTCT was much longer (mean 25.1 sees) and in 32 it was over 16 sees. Thus there was almost no overlap between these two groups. It is suggested that this test should be adopted as a quick and reliable further test to establish a diagnosis of ac-MI (providing other reasons for very short HTCTs can be excluded, e.g. D. I. C., and provinding the patient’s thrombin clotting time is normal).This HTCT measures non-specific heparin neutralizing activity; nevertheless the evidence suggests that it is measuring platelet factor 4 liberated from damaged or “activated” platelets into the plasma. These findings underline the probable important contribution of platelets in ac-MI.

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Use of Circulating MicroRNAs to Diagnose Acute Myocardial Infarction

Clinical Chemistry ◽

10.1373/clinchem.2011.173823 ◽

2012 ◽

Vol 58 (3) ◽

pp. 559-567 ◽

Cited By ~ 160

Author(s):

Yvan Devaux ◽

Mélanie Vausort ◽

Emeline Goretti ◽

Petr V Nazarov ◽

Francisco Azuaje ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Chest Pain ◽

Troponin T ◽

Correct Diagnosis ◽

Patient Treatment ◽

Healthy Controls ◽

Clinical Model ◽

Acute Mi ◽

St Elevation

Abstract BACKGROUND Rapid and correct diagnosis of acute myocardial infarction (MI) has an important impact on patient treatment and prognosis. We compared the diagnostic performance of high-sensitivity cardiac troponin T (hs-cTnT) and cardiac enriched microRNAs (miRNAs) in patients with MI. METHODS Circulating concentrations of cardiac-enriched miR-208b and miR-499 were measured by quantitative PCR in a case-control study of 510 MI patients referred for primary mechanical reperfusion and 87 healthy controls. RESULTS miRNA-208b and miR-499 were highly increased in MI patients (>105-fold, P < 0.001) and nearly undetectable in healthy controls. Patients with ST-elevation MI (n= 397) had higher miRNA concentrations than patients with non–ST-elevation MI (n = 113) (P < 0.001). Both miRNAs correlated with peak concentrations of creatine kinase and cTnT (P < 10−9). miRNAs and hs-cTnT were already detectable in the plasma 1 h after onset of chest pain. In patients who presented <3 h after onset of pain, miR-499 was positive in 93% of patients and hs-cTnT in 88% of patients (P= 0.78). Overall, miR-499 and hs-cTnT provided comparable diagnostic value with areas under the ROC curves of 0.97. The reclassification index of miR-499 to a clinical model including several risk factors and hs-cTnT was not significant (P = 0.15). CONCLUSION Circulating miRNAs are powerful markers of acute MI. Their usefulness in the establishment of a rapid and accurate diagnosis of acute MI remains to be determined in unselected populations of patients with acute chest pain.

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