scholarly journals Iatrogenic Right-Sided Pneumothorax Presenting as ST-Segment Elevation: A Rare Case Report and Review of Literature

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Bashar Alzghoul ◽  
Ayoub Innabi ◽  
Anusha Shanbhag ◽  
Kshitij Chatterjee ◽  
Farah Amer ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Central Venous Line ◽  
Tube Placement ◽  
Review Of Literature ◽  
St Segment Elevation ◽  
Line Insertion ◽  
St Segment ◽  
Rare Case Report ◽  
Electrocardiogram Ecg ◽  
Needle Decompression

Pneumothorax is a well-recognized complication of central venous line insertion (CVL). Rarely, pneumothorax can lead to electrocardiogram (ECG) findings mimicking ST-segment elevation myocardial infarction. We present a 63-year-old man with iatrogenic right-sided pneumothorax who developed ST-segment elevation on a 12-lead ECG suggestive of myocardial infarction. The ECG findings completely resolved after needle decompression and chest tube placement. This case points up this rare electrocardiographic finding with discussion of possible mechanisms and differential diagnosis.

scholarly journals Postoperative ‘STEMI’ in Intracerebral Hemorrhage due to Arteriovenous Malformation: A Case Report and Review of Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Ravinder Datt Bhanot ◽  
Jasleen Kaur ◽  
Shitiz Sriwastawa ◽  
Kendall Bell ◽  
Kushak Suchdev
Keyword(s):  
Myocardial Infarction ◽  
Intracerebral Hemorrhage ◽  
Arteriovenous Malformation ◽  
Cardiac Biomarkers ◽  
Review Of Literature ◽  
Fibrinolytic Agents ◽  
Intraparenchymal Hemorrhage ◽  
Ecg Changes ◽  
St Segment ◽  
Electrocardiogram Ecg

Electrocardiogram (ECG) changes suggestive of cardiac ischemia are frequently demonstrated in patients with ischemic stroke and subarachnoid hemorrhage. However, little is known of such changes particularly acute ST segment myocardial infarction (STEMI) in patients with intracerebral hemorrhage (ICH), especially after neurosurgery. We present a patient with intraparenchymal hemorrhage due to cerebral arteriovenous malformation (AVM) who exhibited acute STEMI after neurosurgery. Serial cardiac biomarkers and echocardiograms were performed which did not reveal any evidence of acute myocardial infarction. The patient was managed conservatively from cardiac stand point with no employment of anticoagulants, antiplatelet therapy, fibrinolytic agents, or angioplasty and recovered well with minimal neurological deficit. This case highlights that diffuse cardiac ischemic signs on the ECG can occur in the setting of an ICH after neurosurgery, potentially posing a difficult diagnostic and management conundrum.

scholarly journals Tension pneumothorax presenting as ST segment elevation: Look, Listen, Act!

2017 ◽  
Vol 11 (7) ◽  
pp. 195-197
Author(s):  
Aditya Naraian Chada ◽  
Naga Venkata Krishna Chand Pothineni ◽  
Swathi Kovelamudi ◽  
Deepa S. Raghavan
Keyword(s):  
Myocardial Infarction ◽  
Critical Care ◽  
Physical Examination ◽  
Tension Pneumothorax ◽  
Unique Case ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Electrocardiogram Ecg ◽  
Electrocardiographic Abnormalities

We present a unique case of a patient with a tension pneumothorax that presented with electrocardiogram (ECG) characteristics typical for ST segment elevation myocardial infarction. The clinical diagnosis was clinched by focused physical examination. Treatment of the pneumothorax lead to resolution of the electrocardiographic abnormalities. Our experience from this unique case is useful for cardiologists and critical care physicians who encounter these patients routinely.

scholarly journals Diagnostic performance and potential clinical impact of advanced care paramedic interpretation of ST-segment elevation myocardial infarction in the field

CJEM ◽  
2006 ◽  
Vol 8 (06) ◽  
pp. 401-407 ◽  
Author(s):  
Michel R. Le May ◽  
Richard Dionne ◽  
Justin Maloney ◽  
John Trickett ◽  
Irene Watpool ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Thrombolytic Therapy ◽  
Predictive Value ◽  
Correct Diagnosis ◽  
St Segment Elevation ◽  
St Segment ◽  
Integrated Programs ◽  
St Elevation ◽  
Potential Clinical Impact ◽  
Electrocardiogram Ecg

ABSTRACT Objectives: Most studies of pre-hospital management of ST-elevation myocardial infarction (STEMI) have involved physicians accompanying the ambulance crew, or electrocardiogram (ECG) transmission to a physician at the base hospital. We sought to determine if Advanced Care Paramedics (ACPs) could accurately identify STEMI on the pre-hospital ECG and contribute to strategies that shorten time to reperfusion. Methods: A STEMI tool was developed to: 1) measure the accuracy of the ACPs at diagnosing STEMI; and 2) determine the potential time saved if ACPs were to independently administer thrombolytic therapy. Using registry data, we subsequently estimated the time saved by initiating thrombolytic therapy in the field compared with in-hospital administration by a physician. Results: Between August 2003 and July 2004, a correct diagnosis of STEMI on the pre-hospital ECG was confirmed in 63 patients. The performance of the ACPs in identifying STEMI on the ECG resulted in a sensitivity of 95% (95% confidence interval [CI] 86%–99%), a specificity of 96% (95% CI 94%–98%), a positive predictive value (PPV) of 82% (95% CI 71%–90%), and a negative predictive value (NPV) of 99% (95% CI 97%–100%). ACP performance for appropriately using thrombolytic therapy resulted in a sensitivity of 92% (95% CI 78%–98%), a specificity of 97% (95% CI 94%–98%), a PPV of 73% (95% CI 59%–85%) and an NPV of 99% (95% CI 97%–100%). We estimated that the median time saved by ACP administration of thrombolytic therapy would have been 44 minutes. Conclusions: ACPs can be trained to accurately interpret the pre-hospital ECG for the diagnosis of STEMI. These results are important for the design of regional integrated programs aimed at reducing delays to reperfusion.

Reversible Stress-induced Cardiomyopathy (Takotsubo) Mimics Acute Anterior Wall ST Segment Elevation Myocardial Infarction: A Case Report with Review of Literature

2016 ◽  
Vol 11 (01) ◽  
pp. 32-38
Author(s):  
Gumpanart Veerakul ◽  
Buranawanich Kiattipoom ◽  
Ngamwong Tawatchai ◽  
Chuaychoowong Issaraporn ◽  
Wongkasai Supatcha ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Anterior Wall ◽  
Review Of Literature ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

ST Elevation is not Always Equivalent to Acute Myocardial Infarction: a Case of Brugada Syndrome

2003 ◽  
Vol 10 (2) ◽  
pp. 121-123
Author(s):  
YF Choi ◽  
AYC Siu ◽  
TW Wong ◽  
CC Lau
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
Thrombolytic Therapy ◽  
Brugada Syndrome ◽  
Diagnostic Tools ◽  
St Segment Elevation ◽  
St Segment ◽  
St Elevation ◽  
Electrocardiogram Ecg

Acute myocardial infarction (AMI) is one of the most alerting situations in emergency department. Electrocardiogram (ECG) is one of the most important diagnostic tools and the decision about thrombolytic therapy is usually based upon ECG findings when clinically suspicious. However, ST segment elevation is not always equivalent to acute myocardial infarction. We present a rare syndrome whose ECG shows persistent ST elevation not related to AMI.

Implications of ventricular arrhythmia “bursts” with normal epicardial flow, myocardial blush, and ST-segment recovery in anterior ST-elevation myocardial infarction reperfusion: A biosignature of direct myocellular injury “downstream of downstream”

2014 ◽  
Vol 4 (1) ◽  
pp. 51-59 ◽  
Author(s):  
Mohamed Majidi ◽  
Andrzej S Kosinski ◽  
Sana M Al-Khatib ◽  
Lilian Smolders ◽  
Ecaterina Cristea ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ventricular Arrhythmia ◽  
Cellular Response ◽  
Multivariable Analysis ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Electrocardiogram Ecg

Aims: Establishing epicardial flow with percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is necessary but not sufficient to ensure nutritive myocardial reperfusion. We evaluated whether adding myocardial blush grade (MBG) and quantitative reperfusion ventricular arrhythmia “bursts” (VABs) surrogates provide a more informative biosignature of optimal reperfusion in patients with Thrombolysis in Myocardial Infarction (TIMI) 3 flow and ST-segment recovery (STR). Methods and results: Anterior STEMI patients with final TIMI 3 flow had protocol-blinded analyses of simultaneous MBG, continuous 12-lead electrocardiogram (ECG) STR, Holter VABs, and day 5–14 SPECT imaging infarct size (IS) assessments. Over 20 million cardiac cycles from >4500 h of continuous ECG monitoring in subjects with STR were obtained. IS and clinical outcomes were examined in patients stratified by MBG and VABs. VABs occurred in 51% (79/154) of subjects. Microcirculation (MBG 2/3) was restored in 75% (115/154) of subjects, of whom 53% (61/115) had VABs. No VABs were observed in subjects without microvascular flow (MBG of 0). Of 115 patients with TIMI 3 flow, STR, and MBG 2/3, those with VABs had significantly larger IS (median: 23.0% vs 6.0%, p=0.001). Multivariable analysis identified reperfusion VABs as a factor significantly associated with larger IS ( p=0.015). Conclusions: Despite restoration of normal epicardial flow, open microcirculation, and STR, concomitant VABs are associated with larger myocardial IS, possibly reflecting myocellular injury in reperfusion settings. Combining angiographic and ECG parameters of epicardial, microvascular, and cellular response to STEMI intervention provides a more predictive “biosignature” of optimal reperfusion than do single surrogate markers.

scholarly journals Predictors of myocardial reperfusion syndrome: a modern view of the issue and current problems. Part 1: Reperfusion arrhythmias, injury and stunning myocardium (review of literature)

2021 ◽  
Vol 20 (2) ◽  
pp. 20-26
Author(s):  
G. G. Khubulava ◽  
K. L. Kozlov ◽  
A. N. Shishkevich ◽  
S. S. Mikhailov ◽  
E. Yu. Bessonov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Groups ◽  
Myocardial Reperfusion ◽  
Review Of Literature ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Long Time ◽  
Long Term Prognosis

Myocardial reperfusion syndrome is a complex set of pathological processes that occur in the heart muscle due to restoration of coronary blood flow in patients with ST-segment elevation myocardial infarction. Despite the fact that it has been known for a long time, there is still no unequivocal opinion about the predictors, and, accordingly, the risk groups for its occurrence. This prevents predicting the further course of the disease and studying the effectiveness of surgical and therapeutic methods for preventing the consequences of reperfusion in patients with ST-segment elevation myocardial infarction, which in turn significantly worsens the postoperative and long-term prognosis in this group of patients. We used the search engines such as E-lilbrary, Google Scholar and Pubmed to search for studies on this issue. The article presents research data highlighting predictors of myocardial reperfusion syndrome. In addition, the problems of verification of irreversible reperfusion injury and myocardial stunning are described.

scholarly journals Community and healthcare system-related factors feeding the phenomenon of evading medical attention for time-dependent emergencies during COVID-19 crisis

2020 ◽  
Vol 13 (8) ◽  
pp. e237817 ◽  
Author(s):  
Taha Ahmed ◽  
Samra Haroon Lodhi ◽  
Samir Kapadia ◽  
Gautam V Shah
Keyword(s):  
Myocardial Infarction ◽  
Late Presentation ◽  
Time Dependent ◽  
Medical Attention ◽  
Review Of Literature ◽  
Related Factors ◽  
St Segment Elevation ◽  
St Segment ◽  
Medical Emergencies ◽  
Potential Factors

The current COVID-19 crisis has significantly impacted healthcare systems worldwide. There has been a palpable increase in public avoidance of hospitals, which has interfered in timely care of critical cardiovascular conditions. Complications from late presentation of myocardial infarction, which had become a rarity, resurfaced during the pandemic. We present two such encounters that occurred due to delay in seeking medical care following myocardial infarction due to the fear of contracting COVID-19 in the hospital. Moreover, a comprehensive review of literature is performed to illustrate the potential factors delaying and decreasing timely presentations and interventions for time-dependent medical emergencies like ST-segment elevation myocardial infarction (STEMI). We emphasise that clinicians should remain vigilant of encountering rare and catastrophic complications of STEMI during this current era of COVID-19 pandemic.

scholarly journals Posterior myocardial infarction with isolated ST elevations in V8 and V9: Is this an “ST elevation MI”?

CJEM ◽  
2003 ◽  
Vol 5 (02) ◽  
pp. 115-118
Author(s):  
Lance Brown ◽  
Jessica Sims ◽  
Alessandra Conforto
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Artery Occlusion ◽  
Primary Angioplasty ◽  
Artery Occlusion ◽  
St Segment Elevation ◽  
St Segment ◽  
St Elevation ◽  
Artery Disease ◽  
Electrocardiogram Ecg

ABSTRACT We report a case of a 53-year-old man whose first manifestation of coronary artery disease was an acute isolated posterior myocardial infarction (IPMI). Acute IPMI is relatively uncommon and predominantly due to occlusion of the left circumflex coronary artery. IPMI is challenging to diagnose due to the absence of ST segment elevation on a standard 12-lead electrocardiogram (ECG) even in the setting of total coronary artery occlusion and transmural (Q-wave) infarct. We discuss the diagnostic implications of the absence of tall R waves in leads V1 and V2 on this patient’s ECG. The utility of posterior leads (V7 through V9) is demonstrated. The controversy surrounding the use of thrombolytic therapy or primary angioplasty in the setting of acute IPMI without ST segment elevation on a standard 12-lead ECG is reviewed.

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