Regional Pericarditis Mimicking Inferior Myocardial Infarction following Abdominal Surgery

Acute pericarditis is common but illusive, often mimicking acute coronary syndrome in its clinical and electrocardiographic presentation. Regional pericarditis, though rare, presents further challenge with a paucity of published diagnostic criteria. We present a case of postoperative regional pericarditis and discuss helpful electrocardiographic findings. A 66-year-old male with history of open drainage of a liver abscess presented with abdominal pain and tenderness. CT of the abdomen was concerning for pneumatosis intestinalis of the distal descending colon. He underwent lysis of liver adhesions; exploration revealed only severe colonic impaction, for which he had manual disimpaction and peritoneal irrigation. Postoperatively, he developed sharp chest pain. Electrocardiogram revealed inferior ST elevation. Echocardiogram revealed normal left and right ventricular dimensions and systolic function without wall motion abnormalities. Emergent coronary angiography did not identify a culprit lesion, and left ventriculogram showed normal systolic function without wall motion abnormalities. He received no intervention, and the diagnosis of regional pericarditis was entertained. His cardiac troponin was 0.04 ng/dL and remained unchanged, with resolution of the ECG abnormalities in the following morning. Review of his preangiography ECG revealed PR depression, downsloping baseline between QRS complexes, and reciprocal changes in the anterior leads, suggestive of regional pericarditis.

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Abstract P178: Echocardiographic Correlates of Persistent Q-Waves in Patients With ST-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.ap178 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

Mikhail Kirnus ◽

Adeyemi Iyanoye ◽

Elizabeth Hubbard ◽

Mikhail Torosoff

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Positive Predictive Value ◽

Predictive Value ◽

Wall Motion ◽

Coronary Intervention ◽

Percutaneous Coronary ◽

History Of ◽

St Elevation ◽

Wall Motion Abnormalities

Background Historic data suggests 65-70% prevalence of Q-waves and concurrent wall motion abnormalities in patients with ST-elevation myocardial infarction (STEMI) treated with thrombolytics. We investigated prevalence of post-MI Q-waves and correlation between Q-waves and left ventricular wall motion abnormalities in STEMI patients treated with primary percutaneous coronary intervention (PCI). Study Design A retrospective study cohort included 145 patients (24% females, 57+/-13 years old) without prior Q-wave MI who underwent successful primary PCI for STEMI at a single academic tertiary center. New York State Angioplasty Registry endpoints were utilized. Echocardiograms and ECGs (median 53 days post STEMI) were reviewed for presence or absence of segmental wall motion abnormalities (WMAs) and Q-waves. ANOVA and chi-square analyses were performed. Results Prevalence of post PCI Q-waves in STEMI patients was 69%, similar to historic 64% in TIMI 14 trial patients (p=0.258). Timing of PCI was not a significant predictor of Q-waves, but there was a trend towards higher pre- and post-PCI creatine kinase and troponin levels in patients with Q-waves. Patients with history of hypertension were less likely to develop Q-waves (62% vs. 77%, p=0.048), while age, gender, history of CHF, COPD, diabetes, renal failure, smoking, and admission hemodynamic status were not predictive of post-PCI Q-waves. WMAs were present in 38% of patients with Q-waves vs. 9% in the rest of the cohort (p=0.0003). Q-waves were equally likely to develop regardless of location of ST elevations at presentation; however, WMAs were more likely in patients with Q-waves in leads II-III-AVF (p=0.008) and V1-2-3 (p<0.0001), V4-5-6 (p=0.008), but not I-AVL (p=0.07). Positive predictive value for WMAs in patients with Q waves was 38%, while negative predictive value for lack of WMAs in patients without Q waves was 91%. Conclusions Prevalence of Q waves, reflective of myocardial damage, in STEMI patients treated with primary coronary intervention is similar to such observed in thrombolysis trials. Positive predictive value of Q-waves for WMAs is low. In CAD patients without Q-waves segmental WMAs are unlikely.

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Acute Cardiogenic Shock Induced by Infusional 5-Fluorouracil

Case Reports in Oncological Medicine ◽

10.1155/2014/819396 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 4

Author(s):

Jeffrey Sulpher ◽

Franco Dattilo ◽

Susan Dent ◽

Michele Turek ◽

M. Neil Reaume ◽

...

Keyword(s):

Wall Motion ◽

Clinical Status ◽

Metastatic Carcinoma ◽

Prior History ◽

History Of ◽

St Elevation ◽

Wall Motion Abnormalities ◽

Carcinoma Of The Bladder ◽

To Receive

A 49-year-old patient with metastatic carcinoma of the bladder and no prior history of heart disease presented with diffuse ST elevation, elevated troponins, and biventricular dysfunction requiring intensive care unit admission and inotropic support after receiving her first course of infusional 5-fluorouracil (5-FU). Over the course of several days, the patient’s cardiac function and clinical status returned to baseline. A follow-up echocardiogram performed 5 days after initial presentation revealed an ejection fraction of 59 percent, with no evidence of wall motion abnormalities. Subsequent 5-FU chemotherapy was discontinued, and the patient went on to receive second-line chemotherapy.

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Stress cardiomyopathy misinterpreted as ST-segment elevation myocardial infarction in a patient with aneurysmal subarachnoid hemorrhage: a case report

Romanian Journal of Internal Medicine ◽

10.2478/rjim-2020-0010 ◽

2020 ◽

Vol 58 (3) ◽

pp. 173-177

Author(s):

Iulian Enache ◽

Răzvan Alexandru Radu ◽

Elena Oana Terecoasă ◽

Bogdan Dorobăţ ◽

Cristina Tiu

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Subarachnoid Hemorrhage ◽

Wall Motion ◽

Myocardial Dysfunction ◽

Endovascular Coiling ◽

Acute Setting ◽

Coronary Syndrome ◽

St Elevation ◽

Wall Motion Abnormalities

AbstractCardiac abnormalities are frequently reported in acute subarachnoid hemorrhage (SAH) patients. However, frank ST-elevation and myocardial dysfunction mimicking acute coronary syndrome is a rare occurrence. Systemic and local catecholamine release mediate myocardial injury and may explain raised troponin levels, concordant regional wall motion abnormalities and systolic dysfunction. These findings can pose a significant problem in the acute setting where “time-is-muscle” paradigm can rush clinicians towards a “rule-in” diagnosis of acute myocardial infarction.We present the case of a 60-year-old male who arrived at a regional emergency department with loss of consciousness, chest pain and headache. His ECG showed ST-elevation in precordial leads with corresponding region wall motion abnormalities and dynamically elevated troponin levels which supported a diagnosis of acute myocardial infarction. Percutaneous coronary intervention was attempted but found no hemodynamically significant lesions and the patient was managed conservatively with antithrombotic treatment. Further work-up for his headache led to the diagnosis of aneurysmal SAH and subsequent endovascular coiling. The patient was discharged with a good clinical outcome. We discuss the potential catastrophic consequences of interpreting neurologic myocardial stunning as STEMI. Use of potent antithrombotic therapies, like bridging thrombolysis, in this setting can lead to dismal consequences. Clinical history should still be carefully obtained in the acute setting in this era of sensitive biomarkers.

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Takotsubo Cardiomyopathy in a Squash Player

Cardiology Research and Practice ◽

10.4061/2009/351621 ◽

2009 ◽

Vol 2009 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Mathieu Berry ◽

Jerome Roncalli ◽

Olivier Lairez ◽

Meyer Elbaz ◽

Didier Carrié ◽

...

Keyword(s):

Takotsubo Cardiomyopathy ◽

Wall Motion ◽

Ventricular Dysfunction ◽

Apical Ballooning ◽

Regional Wall Motion ◽

Left Ventricular ◽

The Body ◽

Coronary Syndrome ◽

Regional Wall Motion Abnormalities ◽

Wall Motion Abnormalities

Takotsubo cardiomyopathy is usually described following acute emotional stress. We report here the case of a 48-year-old woman admitted for acute coronary syndrome after an intensive squash match. Diagnosis of Takotsubo cardiomyopathy due to acute physical stress was suspected in presence of normal coronary arteries and transitory left ventricular dysfunction with typical apical ballooning. Cardiac magnetic resonance imaging confirmed regional wall-motion abnormalities and was helpful in excluding myocardial infarction diagnosis. During squash the body is subject to sudden and vigorous demands inducing a prolonged and severe workload on the myocardium.

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High risk electrocardiographic patterns in patients with acute coronary syndrome.

Archivos Peruanos de Cardiología y Cirugía Cardiovascular ◽

10.47487/apcyccv.v2i1.82 ◽

2020 ◽

Vol 2 (1) ◽

pp. 25-34

Author(s):

Diego Echeverri- Marín ◽

Cristhian Felipe Ramirez Ramos ◽

Andrés Miranda-Arboleda ◽

Gustavo Castilla-Agudelo ◽

Clara Saldarriaga-Giraldo

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Reperfusion Therapy ◽

Early Reperfusion ◽

St Segment Elevation ◽

Coronary Syndrome ◽

Acute Coronary Occlusion ◽

St Segment ◽

St Elevation ◽

Electrocardiographic Findings

Acute myocardial infarction is the leading cause of death in the world and the electrocardiogram remains the diagnostic tool for determining an acute myocardial infarction with ST-segment elevation. In spite of this, only half of the patients present classic electrocardiogram findings compatible with the ST-elevation infarction criteria. There is a spectrum of electrocardiographic findings that may reflect a phenomenon of acute coronary occlusion, which should be promptly recognized by the clinician to offer early reperfusion therapy.

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Echocardiographic wall motion abnormalities in patients with stroke may warrant cardiac evaluation

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2018-320219 ◽

2019 ◽

Vol 90 (7) ◽

pp. 792-795

Author(s):

Shadi Yaghi ◽

Andrew D Chang ◽

Brittany A Ricci ◽

Brian MacGrory ◽

Shawna Cutting ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

Coronary Artery ◽

Ischaemic Stroke ◽

Wall Motion ◽

Cardiac Evaluation ◽

History Of ◽

Wall Motion Abnormalities ◽

Artery Disease

BackgroundThe aetiology of wall motion abnormalities (WMA) in patients with ischaemic stroke is unclear. We hypothesised that WMAs on transthoracic echocardiography (TTE) in the setting of ischaemic stroke mostly reflect pre-existing coronary heart disease rather than simply an isolated neurocardiogenic phenomenon.MethodsData were retrospectively abstracted from a prospective ischaemic stroke database over 18 months and included patients with ischaemic stroke who underwent a TTE. Coronary artery disease was defined as history of myocardial infarction (MI), coronary intervention or ECG evidence of prior MI. The presence (vs absence) of WMA was abstracted. Multivariable logistic regression was used to determine the association between coronary artery disease and WMA in models adjusting for potential confounders.ResultsWe identified 1044 patients who met inclusion criteria; 139 (13.3%, 95% CI 11.2% to 15.4%) had evidence of WMA of whom only 23 (16.6%, 95% CI 10.4% to 22.8%) had no history of heart disease or ECG evidence of prior MI. Among these 23 patients, 12 had a follow-up TTE after the stroke and WMA persisted in 92.7% (11/12) of patients. In fully adjusted models, factors associated with WMA were older age (OR per year increase 1.03, 95% 1.01 to 1.05, p=0.009), congestive heart failure (OR 4.44, 95% CI 2.39 to 8.33, p<0.001), history of coronary heart disease or ECG evidence prior MI (OR 27.03, 95% CI 14.93 to 50.0, p<0.001) and elevated serum troponin levels (OR 2.00, 95% CI 1.06 to 3.75, p=0.031).ConclusionIn patients with ischaemic stroke, WMA on TTE may reflect underlying cardiac disease and further cardiac evaluation may be considered.

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Takotsubo Syndrome Associated with ST Elevation Myocardial Infarction

Case Reports in Cardiology ◽

10.1155/2019/1010243 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Saad Ezad ◽

Michael McGee ◽

Andrew J. Boyle

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Acute Myocardial Infarction ◽

Coronary Artery ◽

Wall Motion ◽

Obstructive Coronary Artery Disease ◽

Takotsubo Syndrome ◽

St Elevation ◽

Wall Motion Abnormalities ◽

Artery Disease

Background. Takotsubo syndrome is a reversible heart failure syndrome which often presents with symptoms and ECG changes that mimic an acute myocardial infarction. Obstructive coronary artery disease has traditionally been seen as exclusion criteria for the diagnosis of takotsubo; however, recent reports have called this into question and suggest that the two conditions may coexist. Case Summary. We describe a case of an 83-year-old male presenting with chest pain consistent with acute myocardial infarction. The ECG demonstrated anterior ST elevation with bedside echocardiography showing apical wall motion abnormalities. Cardiac catheterisation found an occluded OM2 branch of the left circumflex artery with ventriculography confirming apical ballooning consistent with takotsubo and not in the vascular territory supplied by the occluded epicardial vessel. Repeat echocardiogram 6 weeks later confirmed resolution of the apical wall motion abnormalities consistent with a diagnosis of takotsubo. Discussion. This case demonstrates the finding of takotsubo syndrome in a male patient with acute myocardial infarction. Traditionally, this would preclude a diagnosis of takotsubo; however, following previous reports of takotsubo in association with coronary artery dissection and acute myocardial infarction in female patients, new diagnostic criteria have been proposed which allow the diagnosis of takotsubo in the presence of obstructive coronary artery disease. This case adds to the growing body of literature that suggests takotsubo can coexist with acute myocardial infarction; however, it remains to be elucidated if it is a consequence or cause of myocardial infarction.

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