Malignant pheochromocytoma: pain, palpitation, perspiration and perplexities

2021 ◽  
Vol 14 (6) ◽  
pp. e239991
Author(s):  
Nanditha Ananthakrishnan ◽  
Saravanan Sanniyasi ◽  
Daniel Ravikumar
Keyword(s):  
Myocardial Infarction ◽  
Laparoscopic Resection ◽  
Malignant Pheochromocytoma ◽  
Coronary Angiogram ◽  
Left Adrenal Gland ◽  
Alpha Blockers ◽  
Blood Pressures ◽  
St Elevation ◽  
Urine Metanephrines ◽  
Multiple Episodes

A 60-year-old man presented with headache, giddiness, abdominal pain and palpitation. When evaluated outside for the same, the patient was diagnosed to have hypertension and started on antihypertensives for which he did not respond. ECG was suggestive of non-ST elevation myocardial infarction. The patient was subjected to a coronary angiogram, which was normal. Patient had multiple episodes of fluctuating blood pressures. CT of the abdomen showed a 7.1×5.6×8.2 cm mass in the left adrenal gland suggestive of a pheochromocytoma. Serum, urine metanephrines and normetanephrines were elevated. After discussing with the multidisciplinary team, the patient was stabilised with alpha blockers and taken up for laparoscopic left adrenalectomy. Histopathology was reported as pheochromocytoma with a Pheochromocytoma Adrenal Scaled Score of 10/20 suggestive of malignancy. This is one such case of a malignant pheochromocytoma, which was managed successfully despite the perplexities faced in stabilising the crisis followed by laparoscopic resection in a moribund patient.

scholarly journals 040 Non ST-elevation myocardial infarction with a normal coronary angiogram in women: is it serious?

2011 ◽  
Vol 3 (1) ◽  
pp. 13
Author(s):  
Vincent Labbé ◽  
Johanne Silvain ◽  
Nicolas Vignolles ◽  
Anne Bellemain-Appaix ◽  
Olivier Barthelemy ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
St Elevation Myocardial Infarction ◽  
Coronary Angiogram ◽  
Normal Coronary Angiogram ◽  
St Elevation

scholarly journals Dexamethasone Associated ST Elevation Myocardial Infarction Four Days after an Unremarkable Coronary Angiogram—Another Reason for Cautious Use of Steroids: A Case Report and Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Mohamed Shokr ◽  
Ahmed Rashed ◽  
Kusum Lata ◽  
Ashok Kondur
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Spasm ◽  
St Elevation Myocardial Infarction ◽  
Coronary Angiogram ◽  
Review Of The Literature ◽  
Drug Induced ◽  
St Elevation ◽  
Traditional Risk Factors ◽  
Artery Disease

Drug induced myocardial infarction is a known entity with different forms of steroids linked to coronary artery disease (CAD) either through promoting its traditional risk factors, inducing coronary spasm, or by other unidentified mechanisms. Dexamethasone is known to promote an atherogenic and hypercoagulable state. We report a case of a 75-year-old woman who had ST elevation myocardial infarction (STEMI) associated with dexamethasone use just 4 days following an angiogram showing minor luminal irregularities.

scholarly journals Case Report: When Exercise Went Wrong

2020 ◽  
pp. 5-8
Author(s):  
Heng Shee Kim
Keyword(s):  
Myocardial Infarction ◽  
Stress Test ◽  
High Risk Patient ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Safe Procedure ◽  
Coronary Angiogram ◽  
First Line ◽  
Case Presentation ◽  
St Elevation

Background: Exercise stress test (EST) is recommended as the first-line investigation in major guidelines. It believed as a safe procedure. However, there is unignorable complications include hospitalisation, acute myocardial infarction and sudden cardiac death. Case Presentation: We describe a case of a 56-year-old male who underwent exercise stress test and complicated with hemodynamically unstable ventricular tachycardia. He was resuscitated and diagnosed with acute anterior ST-elevation myocardial infarction. Subsequent coronary angiogram showed severe two vessels disease. Conclusion: This illustrates the importance to identify a cohort of high-risk patient pre-EST, along with proper supervision and well-staffed exercise stress test lab in order to provide appropriate lifesaving treatment.

scholarly journals Recurrent spontaneous coronary artery dissection in a middle-aged male athlete patient: a case report

2020 ◽  
Vol 4 (4) ◽  
pp. 1-5
Author(s):  
John J Fitzpatrick ◽  
Awsan Noman ◽  
Nicola Ryan ◽  
Dana K Dawson
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Magnetic Resonance ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Young Women ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Angiogram ◽  
Coronary Artery Dissection ◽  
St Elevation

Abstract Background Spontaneous coronary artery dissection (SCAD) is a rare condition, mainly affecting young women. Cases in male patients are rare, especially with recurrence. Case summary A 59-year-old male non-elite athlete presented as an ST-elevation myocardial infarction following a 5-km run. Urgent coronary angiogram was normal, but cardiac magnetic resonance showed a myocardial infarction. Four years later, he experienced similar chest pain with no ST-elevation on electrocardiogram and a mild troponin rise. Urgent coronary angiogram was initially thought normal but subsequent close inspection confirmed a Type 2b SCAD. Cardiac magnetic resonance showed a small additional myocardial infarction contained within an area of acute myocardial oedema. Discussion Spontaneous coronary artery dissection is more common in young women compared to men and recurrent dissection has been rarely reported in the literature. Cohort studies have shown the rate of recurrent dissection to be 13–16%, but most of the patients in these cohorts are female. Poor data exists on the best treatment of SCAD in men, but given the presence of intramural thrombus, dual antiplatelet therapy was discontinued on the presumption that it may exacerbate an intramural bleeding process.

scholarly journals Lateral ST-elevation myocardial infarction after donation of COVID-19 convalescent plasma in a naïve donor

2021 ◽  
Vol 14 (3) ◽  
pp. e242542
Author(s):  
Pirbhat Shams ◽  
Fateh Ali Tipoo
Keyword(s):  
Myocardial Infarction ◽  
Coronary Thrombosis ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Coronary Angiogram ◽  
Thrombus Aspiration ◽  
Diagonal Branch ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Plasma Donor

A 34-year-old man presented with central chest pain heralded by bilateral arm numbness, tingling and pain soon after donation of 1000 mL of COVID-19 convalescent plasma (CP). ECG showed ST-elevation in lateral leads and coronary angiogram showed large thrombus in diagonal branch of the left anterior descending artery. The patient underwent successful thrombus aspiration and percutaneous coronary intervention of diagonal branch. In this report, we describe a case of coronary thrombosis leading to ST-elevation myocardial infarction in a naïve plasma donor after donation of COVID-19 CP.

scholarly journals Acute ST-Elevation Myocardial Infarction Associated with Metabolic Syndrome and Its Angiographic Outcome

2021 ◽  
Vol 16 (1) ◽  
pp. 49-56
Author(s):  
Reaz Mahmud Huda ◽  
Miliva Mozaffor ◽  
Mohammad Ashraful Alam ◽  
Md Delwar Hossain
Keyword(s):  
Myocardial Infarction ◽  
Metabolic Syndrome ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Coronary Angiogram ◽  
Acute Stemi ◽  
Group I ◽  
Low Hdl ◽  
St Elevation ◽  
Group Ii

Background: Metabolic Syndrome is already one of the major public health problems around the world; it may be more grievous when associated with any cardiac emergency like myocardial infarction (MI). Objective: To evaluate the association of metabolic syndrome and its angiographic effects on patients with Acute ST-Elevation Myocardial Infarction (acute STEMI). Methods: This prospective observational study was done in the Department of Cardiology of the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh, between July and December of 2013. A total 233 patient were selected for data collection; of them 109 were in group I (acute STEMI patients with metabolic syndrome) and 124 in group II (acute STEMI patients without metabolic syndrome). Initial evaluation of the patients was done by history taking and clinical examination. Baseline investigations like ECG, CK(MB), lipid profile, fasting blood sugar, serum creatinine and echocardiography were done. Coronary angiogram (CAG) was done in the Cardiac Cath-Lab facility of the same hospital. Data was analyzed by using SPSS version 16.0. Comparison between groups was done by unpaired t-test, while categorical data was analyzed with Chi-square (c2) test. Results: In patients with metabolic syndrome (group I), most of them (68.9%) had more than 2 metabolic components out of 4; the combinations were: high TG + low HDL (54.6%), DM + high TG (46.9%), raised BP + high TG (38.5%), DM + low HDL (33.6%), raised BP + low HDL (26.4%) and raised BP and DM ( 24.3%).ECG shows that the inferior wall acute myocardial infarction (MI) was 41.28% and 44.55% in group I and group II respectively, while anterior wall was involved 58.71 % and 55.65% cases respectively, which was not statistically significant. Heart failure was significantly more in patients of group I than group II (46.79% vs. 20.97%; p<0.001). Echocardiography reveals that the left ventricular (LV) ejection fraction (EF) was much less in group I than that of group II (42.8±18.07% vs. 50.4±21.2%; p<0.001). Among the patients who underwent coronary angiogram (CAG), the mean Friesinger score were 9.7±2.5 in group I and 7.1±3.3 in group II (p<0.05); it indicated more chances of severe coronary artery disease and fatality in group I patients. Conclusion: Acute ST-elevation myocardial infarction patients with metabolic syndrome have much worse angiographic outcome and poor prognosis than those without metabolic syndrome. J Bngladesh Soc Physiol 2021;16(1): 49-56

scholarly journals Angiographic Significance of ST Depression in Anterior Leads in Acute Inferior ST Elevation Myocardial Infarction.

2021 ◽  
Vol 18 (2) ◽  
pp. 7-10
Author(s):  
Rabindra Simkhada ◽  
Barkadin Khan ◽  
Sanjay Singh KC ◽  
Arjun Budhathoki ◽  
Krishna Chandra Adhikari ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Linear Regression Analysis ◽  
Coronary Angiogram ◽  
Inferior Myocardial Infarction ◽  
Cross Sectional ◽  
Left Anterior Descending Artery ◽  
St Depression ◽  
St Elevation ◽  
Acute Inferior Myocardial Infarction

Background and aims: Electrocardiogram of acute ST elevation inferior myocardial infarction can show concomitant ST depression in anterior leads. We aimed to see its significance on coronary angiogram. Methods: Cross sectional study conducted in Department of Cardiology of Shahid Gangalal National Heart Centre from March 2021 to June 2021. Total of 64 patients of acute inferior myocardial infarction were included consecutively. Electrocardiogram were analyzed for the presence of ST depression in anterior leads (V1-V6). Coronary angiogram were obtained. Linear regression analysis was applied to see correlations. Results: Thirty-four (53.12%) participants had significant ST depression in anterior leads. Their mean age was 64.53±11.67 years. Twenty-two (64.70%) were male. Out of them, 13 (38.23%) were hypertensive, 9 (26.47%) were smoker and 7 (20.58%) were diabetic. Among 30 (46.88%) participants without ST depression, mean age was 56.73±13.31 years and 21 (70%) were male. Out of them, 11 (36.66%) were hypertensive, 12 (40%) were smoker and 11 (33.66%) were diabetic. Culprit vessel was right coronary artery in 22 (64.70%) of those with ST depression and 22 (73.33%) of those without ST depression. Significant left anterior descending artery lesion was seen in 19 (55.88%) of those with ST depression and 3 (10%) of those without depression. Anterior ST depression showed positive correlation with left anterior descending artery lesion. Conclusion: ST depression in anterior leads in acute inferior myocardial infarction can be due to presence of concomitant left anterior descending coronary artery disease.

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