scholarly journals Esophageal Rupture Presenting with ST Segment Elevation and Junctional Rhythm Mimicking Acute Myocardial Infarction

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Wytch Rigger ◽  
Raymond Mai ◽  
P. Tim Maddux ◽  
Stuart Cavalieri ◽  
Joe Calkins
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Clinical Status ◽  
Acute Chest Pain ◽  
Endoscopic Stenting ◽  
Esophageal Rupture ◽  
Junctional Rhythm ◽  
St Segment Elevation ◽  
First Case ◽  
St Segment

Esophageal rupture is a rare but potentially fatal cause of chest pain. The presentation is variable and can mimic other conditions such as aortic dissection, pulmonary embolism, and myocardial infarction (MI). A 71-year-old male with a history of coronary artery disease presented to the ED with complaints of acute chest pain and respiratory distress. Over the next 48 hours, the patient developed dynamic ST segment changes on surface electrocardiogram mimicking an inferolateral ST segment elevation MI accompanied by a junctional rhythm. Curiously, his cardiac enzymes remained negative during this time, but his clinical status continued to deteriorate. A subsequent CT scan demonstrated a lower esophageal rupture, and the patient underwent successful endoscopic stenting. While rare, prompt recognition of esophageal rupture is imperative to improving morbidity and mortality. While esophageal rupture has been noted to cause ST segment elevation before, this appears to be the first case associated with a junctional rhythm.

scholarly journals Gemella Endocarditis Presenting as an ST-Segment-Elevation Myocardial Infarction

2016 ◽  
Vol 43 (3) ◽  
pp. 258-260 ◽  
Author(s):  
Jonathan Winkler ◽  
Sunit-Preet Chaudhry ◽  
Philip H. Stockwell
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Cardiac Catheterization ◽  
Acute Chest Pain ◽  
Initial Presentation ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Septic Embolization ◽  
St Segment

Acute myocardial infarction from septic embolization is a rare initial presentation of endocarditis. We report the case of a 67-year-old man who presented with acute chest pain, in whom emergency cardiac catheterization revealed findings that suggested coronary embolism. The patient was found to have Gemella endocarditis, with its initial presentation an embolic acute ST-segment-elevation myocardial infarction. We suggest that endocarditis be considered among the potential causes of acute myocardial infarction.

Posterior wall myocardial infarction: A case report

2017 ◽  
Vol 70 (1-2) ◽  
pp. 44-47
Author(s):  
Milenko Cankovic ◽  
Snezana Bjelic ◽  
Vladimir Ivanovic ◽  
Anastazija Stojsic-Milosavljevic ◽  
Dalibor Somer ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Chest Pain ◽  
Myocardial Revascularization ◽  
Posterior Wall ◽  
Circumflex Artery ◽  
St Segment Elevation ◽  
Therapeutic Benefits ◽  
St Segment ◽  
Therapeutic Algorithms

Introduction. Acute myocardial infarction is a clinical manifestation of coronary disease which occurs when a blood vessel is narrowed or occluded in such a way that it leads to irreversible myocardial ischemia. ST segment depression in leads V1?V3 on the electrocardiogram points to the anterior wall ischemia, although it is actually ST elevation with posterior wall myocardial infarction. In the absence of clear ST segment elevation, it may be overlooked, leading to different therapeutic algorithms which could significantly affect the outcome. Case report. A 77 year-old female patient was admitted to the Coronary Care Unit due to prolonged chest pain followed by nausea and horizontal ST segment depression on the electrocardiogram in V1?V3 up to 3 mm. ST segment elevation myocardial infarction of the posterior wall was diagnosed, associated with the development of initial cardiogenic shock and ischemic mitral regurgitation. An emergency coronarography was performed as well as primary percutaneous coronary intervention with stent placement in the circumflex artery, the infarct-related artery. Due to a multi-vessel disease, surgical myocardial revascularization was indicated. Conclusion. Posterior wall transmural myocardial infarction is the most common misdiagnosis in the 12 lead electrocardiogram reading. Routine use of additional posterior (lateral) leads in all patients with chest pain has no diagnostic or therapeutic benefits, but it is indicated when posterior or lateral wall infarction is suspected. The use of posterior leads increases the number of diagnosed ST segment elevation myocardial infarctions contributing to better risk assessment, prognosis and survival due to reperfusion therapy.

Predictors of short-term outcome in acute chest pain without ST-segment elevation

2003 ◽  
Vol 92 (2-3) ◽  
pp. 193-199 ◽  
Author(s):  
Juan Sanchis ◽  
Vicent Bodı́ ◽  
Ángel Llácer ◽  
Lorenzo Facila ◽  
Julio Núñez ◽  
...  
Keyword(s):  
Chest Pain ◽  
Acute Chest Pain ◽  
Short Term ◽  
Term Outcome ◽  
St Segment Elevation ◽  
Short Term Outcome ◽  
St Segment

Abstract 15848: Impact of the Covid-19 Pandemic on D2B Activations in a Single, Tertiary Care, Urban Medical Center in the United States

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Philip Lavenburg ◽  
Michael Gannon ◽  
Brian O'Murchu ◽  
Vladimir Lakhter ◽  
Deborah L Crabbe ◽  
...  
Keyword(s):  
Chest Pain ◽  
Symptom Onset ◽  
Mechanical Circulatory Support ◽  
Medical Center ◽  
Acute Chest Pain ◽  
Fluoroscopy Time ◽  
Medical Attention ◽  
Circulatory Support ◽  
St Segment Elevation ◽  
St Segment

Introduction: Initial reports suggest that patients may delay seeking medical attention during the Coronavirus Disease 2019 (COVID-19) pandemic. Our aim was to determine if the COVID-19 outbreak is associated with a higher incidence of late presentations for patients with STEMI, greater need for mechanical circulatory support and PCI. Methods: We retrospectively evaluated consecutive patients that presented to a single, academic medical center with acute chest pain and ST-segment elevation on ECG from March 15 through June 17 in years 2019 and 2020. All patients were referred for emergent coronary angiography and the final cohort consisted of 32 patients. Medical records were reviewed to determine time between symptom onset and hospital arrival, need for PCI and/or mechanical circulatory support, total fluoroscopy time and volume of contrast administration during catheterization. Results: There was no significant difference in age, gender, cardiac risk factors or history of CAD between the cohorts that presented in 2019 compared with 2020 (Table 1). The mean time from symptom onset to arrival in the ED was 6.5 ± 8 and 9.2 ± 17 hours in 2019 and 2020 (p=0.55), respectively. PCI was performed during the index catheterization in 5 (50%) and 21 (95%) patients in 2019 and 2020 (p=0.01), respectively. Mean volume of contrast media used per case was 142 ± 65 ml in 2019 and 237 ± 104 ml in 2020 (p=0.017). There was a trend towards greater need for mechanical circulatory support and total fluoroscopy time during cases in 2020 (Table 1). Conclusions: In patients with suspected STEMI during the COVID-19 pandemic, there was a trend towards longer duration between symptom onset and arrival to the ED. More patients presenting with ST-segment elevation required PCI and there was a trend towards greater utilization of mechanical circulatory support. These findings may reflect a decline in access to outpatient services and/or delays in patients seeking care for acute chest pain.

scholarly journals ST Segment Elevation Is Not Always Myocardial Infarction: A Case of Focal Myopericarditis

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Cyrus M. Munguti ◽  
Samuel Akidiva ◽  
Jacob Wallace ◽  
Hussam Farhoud
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Cardiac Mri ◽  
St Segment Elevation ◽  
St Segment ◽  
Normal Coronary Angiography ◽  
Artery Disease

Protocols exist on how to manage STEMI patients, with well-established timelines. There are times when patients present with chest pain, ST segment elevation, and biomarker elevation that are not due to coronary artery disease. These conditions usually present with normal coronary angiography. We present a case that was clinically indistinguishable from STEMI and that was diagnosed with focal myopericarditis on cardiac MRI.

scholarly journals Comparative Study between 12 and 15 Lead Electrocardiograms for Evaluation of Acute Posterior Myocardial Infarction

2012 ◽  
Vol 4 (2) ◽  
pp. 153-163
Author(s):  
SMA Wahib ◽  
AEMM Islam ◽  
MM Haque ◽  
SMD Hossain ◽  
MM Kamal ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Early Diagnosis ◽  
Comparative Study ◽  
Posterior Wall ◽  
Inferior Myocardial Infarction ◽  
St Segment Elevation ◽  
Wall Movement ◽  
Group I ◽  
St Segment

Background: The ECG diagnosis of acute posterior infarction has traditionally been based on the presence of ST segment depression on the pericardial chest leads. However, such ST segment depression is neither specific nor sensitive for the diagnosis of a posterior infarction. Detection of ST segment elevation in V7- V9 in 15 lead ECG can help in early diagnosis of acute Posterior myocardial infarction. Method: Total of 100 patients Inferior myocardial infarction was evaluated by Electrocardiography in standard 12 lead and 15 lead. The patients were categorized into group I having posterior/ and or associated changes and group II having without posterior changes in ECG. Echocardiography and LVgraphy was done to evaluate the posterior wall movement. Result: For diagnosis of posterior myocardial infarction, 43.3% sensitivity and 95.1% specificity was found in 12 lead ECG, whereas in 15 lead ECG it was 80.0% sensitivity and 95.1% specificity. Conclusion: 15 Lead ECGs (including V7-V9) more sensitive than 12 lead ECGs in diagnosis of acute posterior myocardial infarction. Patient with inferior myocardial infarction or anterior ischemia developed more complications if associated with acute posterior myocardial infarction. 15 lead ECGs can routinely be used in patients with ischaemic type of chest pain. DOI: http://dx.doi.org/10.3329/cardio.v4i2.10460 Cardiovasc. j. 2012; 4(2): 153-163

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