Abstract 15549: Esophagopleural Fistula Associated Regional Pericarditis Mimicking Inferior Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Iain J Thompson ◽  
Jorge Fernandez ◽  
Hiroko Beck
Keyword(s):  
Myocardial Infarction ◽  
Troponin I ◽  
Normal Sinus Rhythm ◽  
Fluid Collection ◽  
Definitive Treatment ◽  
Normal Sinus ◽  
St Segment ◽  
Left Pleural Effusion ◽  
Patient Reported ◽  
Ventricular Response

Introduction: Regional pericarditis is a rare clinical entity that may mimic myocardial infarction (MI) and occurs most frequently after myocardial injury. We describe a unique case of regional pericarditis secondary to esophagopleural fistula (EPF) in a patient presenting to the catheterization lab for suspected ST-segment MI. Results: A 75-year-old man with non-small cell lung cancer presented with hypotension, weakness, dyspnea, and chest pain. The initial electrocardiogram (ECG: Figure 1) revealed normal sinus rhythm with inferior lead ST- segment elevations, a chest X-ray showed a left pleural effusion, and troponin I was <0.01 ng/ml. The patient underwent emergent coronary angiography showing no evidence of obstructive coronary disease. Subsequently, the patient reported palpitations and new onset dysphagia. An ECG revealed atrial fibrillation with rapid ventricular response. A barium esophagram (Figure 2) was performed to evaluate the dysphagia and revealed the presence of an EPF with fluid collection adjacent to the inferior heart border. The patient was treated for pericarditis with colchicine and definitive treatment with esophageal stenting was performed. Conclusions: We describe a case of regional pericarditis secondary to EPF masquerading as inferior MI. Given the prevalence and severity of MI, remaining cognizant of its mimickers such as regional pericarditis is important in clinical practice. This case report highlights the utility of maintaining a broad differential and performing a thorough history and physical both at initial presentation and when new information challenges the initial diagnosis.

Myocarditis case associated with Campylobacter jejuni

2018 ◽  
Vol 43 (5) ◽  
pp. 568-570
Author(s):  
Hakan Ayyildiz ◽  
Mehmet Kalayci ◽  
Nadire Cinkilinc ◽  
Mahmut Bozkurt ◽  
Makbule Kutlu Karadag
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Campylobacter Jejuni ◽  
Bacterial Infections ◽  
Troponin I ◽  
Normal Sinus Rhythm ◽  
Cardiac Enzymes ◽  
Normal Sinus ◽  
Anterior Hemiblock ◽  
High Sensitive Troponin

Abstract Objective Myocarditis is an inflammatory disease of the heart caused by various agents and especially enteroviruses, and it is difficult to diagnose and treat. Myocarditis is rarely associated with bacterial infections. Although the most common bacterial infections are Salmonella spp. and Shigella spp., extremely rare cases of Myocarditis due to Campylobacter jejuni are also reported. Patient and methods A 17-year-old male patient with no previous chronic illness was admitted to our emergency department with complaints of abdominal pain, diarrhea, vomiting, and chest pain. He stated that symptoms began after eating a chicken burger a few days ago. Results In the laboratory tests performed, CK-MB and high sensitive Troponin I values were determined as 33.8 IU/L and 1816 ng/L, respectively. Electrocardiogram results revealed left axis left anterior hemiblock in the normal sinus rhythm as well as a ST-T change in the inferior and lateral derivations. Campylobacter jejuni was detected in the stool sample of the patient. Conclusion Myocarditis is one of the rare complications of C. jejuni infection. Bacterial myocarditis should be considered when troponin and cardiac enzymes are elevated in patients admitted to the emergency department with diarrhea and chest pain.

scholarly journals Loeffler’s endocarditis and possible coronary spasm secondary to eosinophilic coronary periarteritis with ECG change mimicking acute non-ST-segment elevation myocardial infarction: A case report

2020 ◽  
Author(s):  
Fan-xin Kong ◽  
Meng Li ◽  
Chun-Yan Ma ◽  
Ping-ping Meng ◽  
Yong-huai Wang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Differential Diagnosis ◽  
Coronary Artery ◽  
Troponin I ◽  
Hypereosinophilic Syndrome ◽  
Coronary Spasm ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Background Loeffler’s endocarditis is an inflammatory cardiac condition of hypereosinophilic syndrome which rarely involves coronary artery. When coronary artery is involved, known as eosinophilic coronary periarteritis, the clinical presentation, electrocardiographic changes and troponin level are extremely nonspecific and may mimic acute coronary syndrome. It is very important to make differential diagnosis for ECPA in order to avoid the unnecessary further invasive coronary angiography. Case presentation We report a case with chest pain, ST-segment depression in electrocardiogram and increased troponin-I mimicking acute non-ST-segment elevation myocardial infarction. However, quick echocardiography showed endomyocardial thickening with normal regional wall motion, which corresponded to the characteristics of Loeffler’s endocarditis. Emergent blood analysis showed marked increase in eosinophils and computed tomography angiography found no significant stenosis of coronary artery. Manifestations of magnetic resonance imaging consisted with findings of echocardiography. Finally, the patient was diagnosed as Loeffler’s endocarditis and possible coronary spasm secondary to eosinophilic coronary periarteritis. Conclusion This case exhibits the crucial use of quick transthoracic echocardiography and the emergent hematological examination for differential diagnosis in such scenarios as often if electrocardiogram change mimicking myocardial infarction.

scholarly journals Copeptin to rule out myocardial infarction in Blacks versus Caucasians

2018 ◽  
Vol 8 (5) ◽  
pp. 395-403 ◽  
Author(s):  
Neil Beri ◽  
Lori B Daniels ◽  
Allan Jaffe ◽  
Christian Mueller ◽  
Inder Anand ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Troponin I ◽  
Black Population ◽  
P Value ◽  
St Segment Elevation ◽  
Incremental Value ◽  
St Segment ◽  
Rule Out

Background: Copeptin in combination with troponin has been shown to have incremental value for the early rule-out of myocardial infarction, but its performance in Black patients specifically has never been examined. In light of a potential for wider use, data on copeptin in different relevant cohorts are needed. This is the first study to determine whether copeptin is equally effective at ruling out myocardial infarction in Black and Caucasian races. Methods: This analysis of the CHOPIN trial included 792 Black and 1075 Caucasian patients who presented to the emergency department with chest pain and had troponin-I and copeptin levels drawn. Results: One hundred and forty-nine patients were diagnosed with myocardial infarction (54 Black and 95 Caucasian). The negative predictive value of copeptin at a cut-off of 14 pmol/l (as in the CHOPIN study) for myocardial infarction was higher in Blacks (98.0%, 95% confidence interval (CI) 96.2–99.1%) than Caucasians (94.1%, 95% CI 92.1–95.7%). The sensitivity at 14 pmol/l was higher in Blacks (83.3%, 95% CI 70.7–92.1%) than Caucasians (53.7%, 95% CI 43.2–64.0%). After controlling for age, hypertension, heart failure, chronic kidney disease and body mass index in a logistic regression model, the interaction term had a P value of 0.03. A cut-off of 6 pmol/l showed similar sensitivity in Caucasians as 14 pmol/l in Blacks. Conclusions: This is the first study to identify a difference in the performance of copeptin to rule out myocardial infarction between Blacks and Caucasians, with increased negative predictive value and sensitivity in the Black population at a cut-off of 14 pmol/l. This also holds true for non-ST-segment elevation myocardial infarction and, although numbers were small, similar trends exist in the normal troponin population. This may have significant implications for early rule-out strategies using copeptin.

scholarly journals Level of the growth differentiation factor-15 in patients with acute myocardial infarction

Kardiologiia ◽  
2020 ◽  
Vol 60 (11) ◽  
pp. 42-48
Author(s):  
A. A. Sabirzyanova ◽  
A. S. Galyavich ◽  
L. V. Baleeva ◽  
Z. M. Galeeva
Keyword(s):  
Myocardial Infarction ◽  
Correlation Coefficient ◽  
Troponin I ◽  
Statistical Significance ◽  
White Blood Cells ◽  
Rank Correlation ◽  
Growth Differentiation Factor 15 ◽  
St Segment Elevation ◽  
Differentiation Factor ◽  
St Segment

Aim To reveal relationships between growth differentiation factor-15 (GDF-15) and laboratory and instrumental indexes in patients with myocardial infarction in acute phase.Material and methods The study included 118 patients younger than 70 years with ST-segment elevation or non-ST segment elevation myocardial infarction (MI). For these patients, GDF-15 was measured by enzyme immunoassay within 48 h of MI clinical onset along with a routine examination. Statistical significance of differences in qualitative variables was assessed by the Student’s t-test for normal distribution and by the nonparametric Mann-Whitney U-test; significance of differences in quantitative variables was assessed by the Pearson’s chi-squared test. The presence of a relationship between quantitative variables was assessed with the Pearson’s correlation coefficient and the Spearman’s rank correlation coefficient.Results For patients with MI, mean GDF-15 concentration was 2.25±1.0 ng/ml. Moderate correlations were found for GDF-15 and levels of natriuretic peptide (r=0.36, p<0.01), white blood cells (r=0.32, p<0.01), and ejection fraction (Simpson rule) (r=-0.32, p<0.01); weak correlations were found with levels of troponin I (r=0.21, p=0.02) and urea (r=0.20, p=0.04), and interventricular septal thickness by echocardiography (r= -0.26, p<0.01). GDF-15 was higher in patients with ST-segment elevation MI (2.36±1.02 vs 1.99±0.96, p<0.05) and in the presence of hypo- or akinetic areas (2.35±1.05 vs 1.85±0.70, p<0.05). No dependence of GDF-15 on the presence of traditional cardiovascular risk factors was observed.Conclusion GDF-15 correlates with major markers of myocardial injury; its level is higher in patients with ST-segment elevation MI regardless of the infarct location.

scholarly journals No additional value of conventional and high-sensitivity cardiac troponin over clinical scoring systems in the differential diagnosis of type 1 vs. type 2 myocardial infarction

2018 ◽  
Vol 56 (5) ◽  
pp. 702-709 ◽  
Author(s):  
Luciano Consuegra-Sánchez ◽  
Juan José Martínez-Díaz ◽  
Luis García de Guadiana-Romualdo ◽  
Samantha Wasniewski ◽  
Patricia Esteban-Torrella ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Troponin T ◽  
Characteristic Curve ◽  
High Sensitivity ◽  
St Segment ◽  
Clinical Scoring

AbstractBackground:The distinction of type 1 and type 2 myocardial infarction (MI) is of major clinical importance. Our aim was to evaluate the diagnostic ability of absolute and relative conventional cardiac troponin I (cTnI) and high-sensitivity cardiac troponin T (hs-cTnT) in the distinction between type 1 and type 2 MI in patients presenting at the emergency department with non-ST-segment elevation acute chest pain within the first 12 h.Methods:We measured cTnI (Dimension Vista) and hs-cTnT (Cobas e601) concentrations at presentation and after 4 h in 200 patients presenting with suspected acute MI. The final diagnosis, based on standard criteria, was adjudicated by two independent cardiologists.Results:One hundred and twenty-five patients (62.5%)were classified as type 1 MI and 75 (37.5%) were type 2 MI. In a multivariable setting, age (relative risk [RR]=1.43, p=0.040), male gender (RR=2.22, p=0.040), T-wave inversion (RR=8.51, p<0.001), ST-segment depression (RR=8.71, p<0.001) and absolute delta hs-cTnT (RR=2.10, p=0.022) were independently associated with type 1 MI. In a receiver operating characteristic curve analysis, the discriminatory power of absolute delta cTnI and hs-cTnT was significantly higher compared to relative c-TnI and hs-cTnT changes. The additive information provided by cTnI and hs-cTnT over and above the information provided by the “clinical” model was only marginal.Conclusions:The diagnostic information provided by serial measurements of conventional or hs-cTnT is not better than that yielded by a simple clinical scoring model. Absolute changes are more informative than relative troponin changes.

scholarly journals Atrial Fibrillation Caused by Intractable Hiccups: A Unique Cause and Cure

2022 ◽  
Vol 2022 ◽  
pp. 1-4
Author(s):  
Joshua H. Arnold ◽  
Neil Brandon
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
Electrical Cardioversion ◽  
Traditional Treatment ◽  
Cardiac Pathology ◽  
Normal Sinus ◽  
First Time ◽  
Intractable Hiccups

We present the case of a 61-year-old male who developed persistent hiccups concurrently with the onset of atrial fibrillation (AF). The hiccups were refractory to traditional treatment but resolved immediately upon electrical cardioversion (ECV) to normal sinus rhythm (NSR). The patient has remained in NSR and free of hiccups. The potential etiologies for hiccups are numerous and varied, and the management of persistent hiccups can be difficult. Cardiac associations including myocardial infarction and pericarditis have been described, while few cases of first-time onset of atrial fibrillation leading to hiccups have been documented. This case discusses a unique instance demonstrating a connection between hiccups and cardiac pathology and an overview of its management.

scholarly journals Association between high-sensitivity cardiac troponin I measured at emergency department and complications of emergency coronary artery bypass grafting

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Jungchan Park ◽  
Seung-Hwa Lee ◽  
Jeong Jin Min ◽  
Jong-Hwan Lee ◽  
Ji Hye Kwon ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Artery Bypass ◽  
Kidney Injury ◽  
High Sensitivity ◽  
Clinical Impact ◽  
Bypass Grafting ◽  
St Segment Elevation ◽  
St Segment

AbstractHigh-sensitivity cardiac troponin I (hs-cTnI) is a widely used biomarker to identify ischemic chest pain in the Emergency Department (ED), but the clinical impact on emergency coronary artery bypass grafting (eCABG) remains undetermined. We aimed to evaluate the clinical impact of hs-cTnI measured at the ED by comparing outcomes of eCABG in patients with non–ST-segment–elevation acute coronary syndrome (NSTE-ACS) which comprises unstable angina (UA) and non–ST-segment–elevation myocardial infarction (NSTEMI). From January 2012 to March 2016, 242 patients undergoing eCABG were grouped according to serum hs-cTnI level in the ED. The primary endpoint was major cardiovascular cerebral event (MACCE) defined as a composite of all-cause death, myocardial infarction, repeat revascularization, and stroke. The incidence of each MACCE composite, in addition to postoperative complications such as acute kidney injury, reoperation, atrial fibrillation, and hospital stay duration were also compared. Patients were divided into two groups: UA [<0.04 ng/mL, n = 102] and NSTEMI [≥0.04 ng/mL, n = 140]. The incidence of MACCE did not differ between the two groups. Postoperative acute kidney injury was more frequent in the NSTEMI group after adjusting for confounding factors (6.9% vs. 23.6%; odds ratio, 2.76; 95% confidence interval, 1.09–6.99; p-value = 0.032). In-hospital stay was also longer in the NSTEMI group (9.0 days vs. 15.4 days, p-value = 0.008). ECABG for UA and NSTEMI patients showed comparable outcomes, but hs-cTnI elevation at the ED may be associated with immediate postoperative complications.

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