scholarly journals Gastric perforation mimicking ST-segment elevation myocardial infarction

2021 ◽  
Vol 14 (3) ◽  
pp. e237470
Author(s):  
Ryan Enast Intan ◽  
Fani Suslina Hasibuan ◽  
Parama Gandi ◽  
Firas F Alkaff
Keyword(s):  
Myocardial Infarction ◽  
Gastric Perforation ◽  
Management Strategies ◽  
High Morbidity ◽  
Ecg Changes ◽  
St Segment Elevation ◽  
Presenting Symptoms ◽  
Acute Peritonitis ◽  
St Segment ◽  
Main Instrument

ST-elevation myocardial infarction (STEMI) is one of the medical emergencies in cardiology with high morbidity and mortality rate which requires rapid response. In elderly patients, its presenting symptoms may be atypical which may cause the diagnosis of MI to be delayed or missed. Therefore, ST-segment elevation on ECG has become the main instrument for initial diagnosis. However, there are a variety of conditions mimicking the ECG changes of STEMI. We report a case of 70-year-old patient with acute peritonitis and pneumoperitoneum secondary to gastric perforation with dynamic ECG changes mimicking anteroseptal STEMI. After the surgery, the ECG dynamically reverted to normal. He was then discharged after 4 days without any remaining symptoms. Misinterpretation of ECG findings may lead to unnecessary aggressive intervention, costly management strategies and delay in appropriate treatment.

Outcomes of nonagenarians with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Echarte Morales ◽  
P.L Cepas Guillen ◽  
G Caldentey ◽  
E Martinez Gomez ◽  
J Borrego-Rodriguez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk Population ◽  
High Morbidity ◽  
Baseline Characteristic ◽  
Invasive Approach ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
All Cause Mortality

Abstract Background Myocardial infarction (MI) in nonagenarians is associated with high morbidity and mortality. Nonetheless, this population has typically been underrepresented in cardiovascular clinical trials. Objective The aim of this study was to evaluate outcomes of nonagenarian patients presenting with MI who underwent either conservative or invasive management. Methods We retrospectively included all consecutive patients equal to or older than 90yo admitted with non-ST segment elevation (NSTEMI) or ST segment elevation MI (STEMI) in four tertiary care centers between 2005 and 2018. Patients with type 2 myocardial infarction were excluded. We collected patients' baseline characteristic and procedural data. In-hospital and at 1-year follow-up all-cause mortality and major adverse cardiovascular events were assessed. Results 523 patients (mean age 92.6±2 years; 60% females) were analyzed. Overall, 184 patients (35.2%) underwent percutaneous coronary intervention (PCI), increasing over the years, mostly in STEMI group (from 16% of patients in 2005 to 75% in 2018). PCI was preferred in those subjects with less prevalence of disability for activities of daily living (p<0.01). The use of a radial access (76.6%) and bare metal stents (52.7%) was predominant. No significant differences were found in the incidence of major bleeding events or MI-related mechanical complications between both strategies. During index hospitalization, 99 (18.9%) patients died. Whereas no differences were found in the NSTEMI group (p=0.61), a significant lower in-hospital mortality was observed in STEMI group treated with PCI (p<0.01). At one-year follow up, 203 (38.8%) patients died, most of them due to a cardiovascular cause (60.6%). PCI was related to a lower all-cause mortality in either NSTEMI (p<0.01) or STEMI groups (p<0.01) however, lower cardiovascular mortality was only found in STEMI group (p=0.03). Conclusion An invasive approach was performed in over a third of nonagenarian patients, carrying prognostic implications and with a few numbers of complications. PCI seems to be the preferred strategy for STEMI in this high-risk population in spite of age. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Type A Aortic Dissection Masquerading as an Inferior Myocardial Infarction

Aorta ◽  
2021 ◽  
Vol 09 (05) ◽  
pp. 184-185
Author(s):  
Azhar Hussain ◽  
Alessia Rossi ◽  
Alexander Smith ◽  
Ana Lopez-Marco ◽  
Amina Khalil ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Aortic Dissection ◽  
Clinical Manifestations ◽  
Type A ◽  
Type A Aortic Dissection ◽  
St Segment Elevation ◽  
Presenting Symptoms ◽  
St Segment ◽  
Wide Range ◽  
Threatening Condition

AbstractType A aortic dissection is a life-threatening condition with a wide range of clinical manifestations. Dissection can sometimes mimic an acute myocardial infarction due to similar presenting symptoms and initial clinical investigations. We report the case of a 52-year-old male who presented with an inferior ST-segment elevation myocardial infarction with two drug-eluting stents inserted as a stabilizing intervention prior to surgical repair of an acute aortic dissection.

P4617Early electrocardiographic changes as markers of coronary microvascular obstruction in acute myocardial infarction with ST segment elevation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C S Garcia Talavera ◽  
A Camblor Blasco ◽  
A L Rivero Monteagudo ◽  
M B Arroyo Rivera ◽  
M Cortes Garcia ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Multivariate Analysis ◽  
Poor Prognosis ◽  
Microvascular Obstruction ◽  
Univariate Analysis ◽  
Ecg Changes ◽  
St Segment Elevation ◽  
St Segment ◽  
Increased Risk ◽  
The Mean

Abstract Background Coronary microvascular obstruction (CMVO), occurs frequently even after a quickly epicardial revascularization of the infarct-related artery (IRA), and has been associated with an increased risk of adverse cardiovascular events and poor prognosis in patients with ST-segment myocardial infarction (STEMI). After primary coronary intervention (PCI), incomplete ST-segment elevation (STE) resolution in the ECG has been related to CMVO and worse clinical outcome. However, there is lack of information regarding other ECG changes. The aim of this study is to describe the initial ECG changes in STEMI and evaluate their association with CMVO. Methods From January 2007 to December 2017, all patients with the diagnosis of STEMI that underwent urgent coronary angiography were retrospectively included. Clinical, echocardiographic, and electrocardiographic data were taken from medical records. A univariate and multivariate analysis was performed to evaluate the relationship between initial ECG changes (before PCI) and CMVO defined as final TIMI <3 in the IRA. Results 1022 patients were included; the mean age was 67.8 years (±14), 73.7% were male and 14.4% had previous coronary artery disease. The most frequent IRA was the anterior descending artery in 43.2% of the cases and CMVO was found in 18.3% of the patients. The mean value of STE sum (defined as the sum of STE in V1-V6, I and aVL in anterior STEMI and the sum of II, III, aVF, V5 and V6 in non-anterior STEMI), maximum STE in one lead and number of leads with STE was 11.36mm (± 8.2), 3.65mm (± 2.3) and 4.14mm (± 1.4), respectively. After a univariate analysis, STE sum, maximum STE in one lead and number of leads with STE were associated with CMVO, while only STE sum remained significantly associated with the presence of CMVO after a multivariate analysis (Table). The resolution of STE in the first 2 hours after PCI was a protector factor for CMVO. Univariate and Multivariate Analysis Univariate Multivariate Variables OR 95% CI p OR IC 95% p Sum of STE 1.03 1.01–1.04 0.013 1.03 1.01–1.05 0.005 Number of leads with STE 1.13 1.02–1.26 0.021 1.04 0.87–1.23 0.67 Maximum STE 1.09 1.02–1.16 0.016 1.04 0.92–1.17 0.49 Resolution of STE 0.35 0.25–0.49 <0.001 0.36 0.25–1.18 <0.001 STE, ST-segment elevation. Conclusion Initial ECG changes such as STE sum, number of leads with STE and maximum STE in one lead can be used as early predictors of CMVO and poor prognosis. STE resolution in the first 2 hour was associated with a lower incidence of CMVO as reported in previous studies. Acknowledgement/Funding None

scholarly journals MP028: Dynamic changes of prehospital serial 12-lead electrocardiogram for remote diagnosis of suspected ST-segment elevation myocardial infarction

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S75-S76
Author(s):  
L. Lau ◽  
J. Lebon ◽  
F. Begin ◽  
A.B. Tanguay
Keyword(s):  
Myocardial Infarction ◽  
Monitoring System ◽  
Ecg Monitoring ◽  
Remote Diagnosis ◽  
Ecg Changes ◽  
Dynamic Changes ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Clinical Databases ◽  
St Segment

Introduction: Accurate and efficient interpretation of prehospital 12-lead electrocardiogram (ECG) in patients with suspected ST-segment elevation myocardial infarction (STEMI) can improve outcomes, especially in rural regions. In the Chaudière-Appalaches region, Quebec, a prehospital serial 12-lead ECG monitoring system is used for remote interpretation of ECG abnormalities by emergency physicians via a telemedicine platform, the Unité de Coordination Clinique des Soins Préhospitaliers d'Urgence (UCCSPU). The objective of the study was to evaluate the use of serial monitoring of dynamic ECG changes in patients with suspected STEMI during emergency medical services (EMS) transport. Methods: A retrospective cohort study with suspected STEMI patients monitored with prehospital serial ECGs was performed from August 2006 to December 2013. The data was extracted from UCCSPU clinical databases and verified by an emergency physician supervisor. During EMS transport, the serial ECG monitoring system automatically produced and transmitted every 2 minutes a 12-lead ECG without artefacts. STEMI criteria were based on the Third Universal Definition of Myocardial Infarction. Dynamic ECG change was defined as an ST-segment elevation or depression that meets diagnostic criteria (eg. initial non STEMI (NSTEMI) changing to STEMI and vice versa). Results: Among the 752 patients identified with suspected STEMI, 728 (96.8%) were included in the study due to missing data. The majority (614/728; 84.3%) had a consistent ST segment without significant dynamic changes throughout transport, of which 521 were identified as STEMI and 93 as NSTEMI. The remaining 114 patients (15.7%) had dynamic ECG changes: 41 (36%) evolved from NSTEMI to STEMI, 40 (35.1%) changed from STEMI to NSTEMI, and 33 (28.9%) had more than one dynamic ST-segment change. Overall, 59 patients (8.1%) had a final STEMI ECG diagnosis after an initial NSTEMI ECG interpretation. Conclusion: In this study, the serial ECG system enabled the remote diagnosis of STEMI in 8.1% of patients during EMS transport following an initial NSTEMI diagnosis. Serial monitoring of dynamic changes can allow for more rapid diversion to primary percutaneous coronary intervention facilities, potentially improving patient outcomes. Further studies are needed to evaluate the clinical impact, and costs and benefits of implementing this technology.

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

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.

scholarly journals Clinical Characteristics, Management Strategies, and Outcomes of Non–ST‐Segment–Elevation Myocardial Infarction Patients With and Without Prior Coronary Artery Bypass Grafting

2021 ◽  
Author(s):  
Ahmad Shoaib ◽  
Muhammad Rashid ◽  
Colin Berry ◽  
Nick Curzen ◽  
Evangelos Kontopantelis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Artery Bypass ◽  
Management Strategies ◽  
Coronary Intervention ◽  
Prior History ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Group 2 ◽  
Group 1

Background There are limited data on the management strategies, temporal trends and clinical outcomes of patients who present with non–ST‐segment–elevation myocardial infarction and have a prior history of CABG. Methods and Results We identified 287 658 patients with non–ST‐segment–elevation myocardial infarction between 2010 and 2017 in the United Kingdom Myocardial Infarction National Audit Project database. Clinical and outcome data were analyzed by dividing into 2 groups by prior history of coronary artery bypass grafting (CABG): group 1, no prior CABG (n=262 362); and group 2, prior CABG (n=25 296). Patients in group 2 were older, had higher GRACE (Global Registry of Acute Coronary Events) risk scores and burden of comorbid illnesses. More patients underwent coronary angiography (69% versus 63%) and revascularization (53% versus 40%) in group 1 compared with group 2. Adjusted odds of receiving inpatient coronary angiogram (odds ratio [OR], 0.91; 95% CI, 0.88–0.95; P <0.001) and revascularization (OR, 0.73; 95% CI, 0.70–0.76; P <0.001) were lower in group 2 compared with group 1. Following multivariable logistic regression analyses, the OR of in‐hospital major adverse cardiovascular events (composite of inpatient death and reinfarction; OR, 0.97; 95% CI, 0.90–1.04; P =0.44), all‐cause mortality (OR, 0.96; 95% CI, 0.88–1.04; P =0.31), reinfarction (OR, 1.02; 95% CI, 0.89–1.17; P =0.78), and major bleeding (OR, 1.01; 95% CI, 0.90–1.11; P =0.98) were similar across groups. Lower adjusted risk of inpatient mortality (OR, 0.67; 95% CI, 0.46–0.98; P =0.04) but similar risk of bleeding (OR,1.07; CI, 0.79–1.44; P =0.68) and reinfarction (OR, 1.13; 95% CI, 0.81–1.57; P =0.47) were observed in group 2 patients who underwent percutaneous coronary intervention compared with those managed medically. Conclusions In this national cohort, patients with non–ST‐segment–elevation myocardial infarction with prior CABG had a higher risk profile, but similar risk‐adjusted in‐hospital adverse outcomes compared with patients without prior CABG. Patients with prior CABG who received percutaneous coronary intervention had lower in‐hospital mortality compared with those who received medical management.

scholarly journals Hypercalcaemia Mimicking STEMI on Electrocardiography

2010 ◽  
Vol 2010 ◽  
pp. 1-3 ◽  
Author(s):  
Joseph Donovan ◽  
Mark Jackson
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Disease ◽  
Ecg Changes ◽  
Common Cause ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Risk Patients ◽  
Electrocardiogram Ecg

Acute coronary syndrome is a common cause of presentation to hospital. ST segment elevation on an electrocardiogram (ECG) is likely to be cardiac in origin, but in low-risk patients other causes must be ruled out. We describe a case of a man with hypercalcaemia, no evidence of cardiac disease, and ECG changes mimicking acute myocardial infarction. These ECG changes resolved after treatment of the hypercalcaemia.

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