scholarly journals A Rare Case of Cardiogenic Shock following Severe Multivessel Coronary Vasospasm

2019 ◽  
Author(s):  
Reza Rahmani ◽  
Amirfarhangh Zand Parsa ◽  
Alborz Sherafati ◽  
Rouzbeh Kosari ◽  
Vahid Mohhamadi ◽  
...  
Keyword(s):  
Chest Pain ◽  
Cardiac Death ◽  
Rare Case ◽  
Recurrent Attack ◽  
St Segment Elevation ◽  
St Segment ◽  
Life Threatening ◽  
Vascular Beds ◽  
Typical Chest Pain

Prinzmetal’s angina occurs following spasms in a single or multiple vascular beds, resulting in a typical chest pain and an ST-segment elevation in electrocardiography (ECG). It can lead to life-threatening arrhythmias and sudden cardiac death. We describe a 37-year-old woman who was admitted with a typical chest pain and hypotension. Her initial ECG showed an ST-segment elevation in the inferior and precordial leads. She was transferred to the catheterization unit, where coronary angiography illustrated multivessel spasms. The spasms were relieved with a nitroglycerin injection. She was discharged with stable hemodynamics 7 days later, and at 1 month’s follow-up, no recurrent attack was detected.

scholarly journals Fast assessment and management of chest pain patients without ST-elevation in the pre-hospital gateway (FamouS Triage): ruling out a myocardial infarction at home with the modified HEART score

2017 ◽  
Vol 7 (2) ◽  
pp. 102-110 ◽  
Author(s):  
Maycel Ishak ◽  
Danish Ali ◽  
Marion J Fokkert ◽  
Robbert J Slingerland ◽  
Rudolf T Tolsma ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Troponin T ◽  
St Segment Elevation ◽  
Heart Score ◽  
St Segment ◽  
Highly Sensitive ◽  
Highly Sensitive Troponin ◽  
Pain Patients

Background: The first study of the FamouS Triage project investigates the feasibility of ruling out a myocardial infarction in pre-hospital chest pain patients without electrocardiographic ST-segment elevation by using the modified HEART score at the patient’s home, incorporating only a single highly sensitive troponin T measurement. Methods: A venous blood sample was drawn in the ambulance from 1127 consecutive chest pain patients for measurement of the pre-hospital highly sensitive troponin T levels, in order to establish a pre-hospital HEART score (i.e. the modified HEART score) and evaluate the possibility of triage at the patient’s home. The primary endpoint was the occurrence of a major adverse cardiac event (MACE) i.e. acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting or death within 30 days after initial presentation. Results: Two hundred and six patients (18%) developed a MACE during 30 days of follow-up. Thirty-six per cent of the patients ( n=403) had a low modified HEART score (0–3 points) and none of them developed a MACE during follow-up. Forty-four per cent of the patients ( n=494) had an intermediate modified HEART score (4–6 points) and 18% of them developed a MACE. Twenty per cent of the patients ( n=230) had a high modified HEART score (7–10 points) of which 52% developed a MACE during follow-up. Conclusion: It seems feasible to rule out a myocardial infarction at home in chest pain patients without ST-segment elevation by using the modified HEART score. TRIAL ID: NTR4205. Dutch Trial Register [ http://www.trialregister.nl ]: trial number 4205.

scholarly journals P862 A conservative strategy for a frequently fatal post-myocardial infarction mechanical complication

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J Ferreira ◽  
A Freitas ◽  
J Loureiro ◽  
M Beringuilho ◽  
D Faria ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Chest Pain ◽  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Post Myocardial Infarction ◽  
Conservative Strategy ◽  
St Segment Elevation ◽  
St Segment

Abstract A 88-year-old female was admitted for an anterior ST-segment elevation myocardial infarction (STEMI). Patient had a history of intermittent chest pain for 2 days with worsening on the day of admission. Electrocardiogram (ECG) at admission showed ST-segment elevation on leads from V2 to V6 and leads DI and aVL. Initial observation on the emergency department was described as unremarkable apart from the chest pain. Aspirin and Ticagrelor loading doses were administered and patient underwent emergent coronary angiography, which showed left anterior descendent artery occlusion after the emergence of second diagonal branch. Coronary angioplasty of this lesion was tried, with a total of 3 drug-eluted stents implantation but with no success as in the end there was no reflow of the artery. Patient was then admitted on cardiac intensive care unit, and on observation at that time there was a remarking holosystolic murmur. Transthoracic echocardiogram showed (apart from left ventricle systolic disfunction with akinesia of the apical segments as well as middle segments of the interventricular septum (IVS) and anterior wall) an apical IVS defect with a left to right shunt with a gradient of around 50mmHg evaluated by Doppler, and no signs of right ventricle overload. Case was promptly discussed with cardiothoracic surgery and it was decided that she was not a candidate to urgent surgical intervention. Patient had an initial evolution in Killip class II, and remained hemodynamically stable for the rest of the admission, having no signs of heart failure on discharge at 17 days later. Serial ETTs during admission and at discharge were similar to the evaluation performed at admission. In the meanwhile, during admission, case was discussed in multidisciplinary heart team with cardiothoracic surgery and interventional cardiology. Given the favourable evolution and comorbidities and frailty of the patient it was decided to adopt a conservative strategy with medical follow-up, only considering intervention if there was worsening of heart failure. Until now, with 4 months follow-up, patient remains in New York Heart Association (NYHA) functional class I. Discussion Post-myocardial infarction ventricular septal defect (VSD) is a complication that, regardless of the treatment strategy has a high mortality rate, especially when patient presents in cardiogenic shock. However, when patient is stable and especially when comorbidities imposes a high interventional risk medical treatment can be an option. So far, this is a successful case of a medically managed post-myocardial infarction VSD. Abstract P862 Figure. Ventricular Septal Defect

scholarly journals Typical chest pain and precordial leads ST-elevation in patients with pacemakers - are we always looking at an acute myocardial infarction?

2015 ◽  
Vol 72 (9) ◽  
pp. 837-840
Author(s):  
Marina Ostojic ◽  
Tatjana Potpara ◽  
Marija Polovina ◽  
Mladen Ostojic ◽  
Miodrag Ostojic
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
Case Report ◽  
Chest Pain ◽  
Pacemaker Implantation ◽  
Ecg Changes ◽  
St Segment Elevation ◽  
St Segment ◽  
Typical Chest Pain

Introduction. Electrocardiographic (ECG) diagnosis of acute myocardial infarction (AMI) in patients with paced rhythm is difficult. Sgarbossa?s criteria represent helpful diagnostic ECG tool. Case report. A 57-year-old female patient with paroxysmal atrial fibrillation and a permanent pacemaker presented in the Emergency Department with prolonged typical chest pain and ECG recording suggestive for AMI. Documented ECG changes correspond to the first Sgarbossa?s criterion for AMI in patients with dual pacemakers (ST-segment elevation of ? 5 mm in the presence of the negative QRS complex). The patient was sent to catheterization lab where coronary angiogram reveled normal findings. ECG changes occurred due to pericardial reaction following two interventions: pacemaker implantation a month before and radiofrequency catheter ablation of AV junction two weeks before presentation in Emergency Department. Conclusion. This case report points out to the limitations of proposed criteria that aid in the recognition of AMI in patients with underlying paced rhythm and possible cause(s) of transient electrocardiographic abnormalities.

scholarly journals P245 Acute ST segment elevation MI in a patient following negative dobuatmine stress echocardiography: Possible mechanisms and lessons to learn

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
T S Lwin ◽  
M Alama ◽  
M Farooq ◽  
N Shaukat
Keyword(s):  
Myocardial Infarction ◽  
Heart Rate ◽  
Chest Pain ◽  
Stress Echocardiography ◽  
Maximum Dose ◽  
Fractional Flow ◽  
St Segment Elevation ◽  
Flow Reserve ◽  
St Segment ◽  
Life Threatening

Abstract Funding Acknowledgements No Funding Background Dobutamine stress echocardiography (DSE) has been used as a safe stress modality for assessing myocardial ischemia. Acute myocardial infarction is one of the rare complications of DSE. In this report, we will discuss a case of a 60 year old lady who developed anterior ST-segment elevation myocardial infarction(STEMI) after a negative DSE. Case report 60 year old lady with a background of PCI to LAD in 2009 presented with angina , a repeat angiogram showed mild to moderate in stent restenosis (ISR) within the LAD but instant wave-free ratio (IFR ) was 0.94 , Fractional Flow Reserve(FFR) 0.84 and negative IVUS studies. Despite that, the patient continued to have chest pain with effort and therefore a DSE was requested. The patient was stressed with intravenous Dobutamine with a maximum dose of 40mcg/kg/min plus 600mcg of atropine. There was no evidence of ischemia. The Patient developed chest pain 15 minutes later. ECG was done and showed ST elevation in anterior leads. Urgent angiography was undertaken which showed acute thrombotic occlusion in the mid LAD with TIMI 0 flow (within the area where ISR had been seen previously) (fig1) . Percutaneous intervention was undertaken and TIMI III flow was restored. Discussion Acute STEMI within a few hours after normal DSE is very rare with an incidence of 0.02% (range 0.00% to 0.10%) Plaque destabilisation and rupture are the possible underlying mechanisms behind coronary occlusion. Interestingly, most of the cases happen within 30 mins after the test. The activation of sympathetic nervous system leads to increased catecholamines, blood viscosity, arterial pressure and heart rate, which are accompanied by detectable increase in platelet aggregation and decrease in fibrinolytic activity that both tend to favour thrombosis. This could lead to propagation of mural thrombus overlying a small plaque erosion that might otherwise have been harmless. Another interesting learning point is the correlation between chronotropic incompetence (CI) and myocardial ischaemia. Low basal heart rate is one of the predictors of CI (baseline average heart rate of 60 bpm in our case, and she managed to achieve only 81% of target Heart rate (THR) despite the maximum dose of dobutamine and atropine). Many studies examined the significance of CI. Impaired Chronotropic response is associated with an increased risk of mortality and MI. Possible explanation is that patients with CI fail to demonstrate or underestimate extent of ischemia. With the experience of our case and similar cases from the literature, we suggest symptoms of chest pain should be seriously attended even after a normal DSE. The risk of life-threatening complication should be informed to patients and enough time should be taken for observation post stress test. More research is needed to clarify the role of DSE in CI patients on account of its potential normal result with submaximal THR and risk of life threatening cardiac event. Abstract P245 Figure. Coronary Angiogram fig1

scholarly journals Association of Cystatin C with Metabolic Syndrome and Its Prognostic Performance in Non-ST-Segment Elevation Acute Coronary Syndrome with Preserved Renal Function

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Qi Mao ◽  
Ning Zhao ◽  
Yuqing Wang ◽  
Youmei Li ◽  
Chaojun Xiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Renal Function ◽  
Cystatin C ◽  
Cardiac Death ◽  
Independent Predictor ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Objective.The underlying mechanisms by which cystatin C affects cardiovascular disease (CVD) are not very clear. Metabolic syndrome (MetS) is a cluster of risk factors that increase the risk of CVD. Here, we aimed to investigate the association of cystatin C with metabolic syndrome and cardiovascular outcomes in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) with preserved renal function.Methods.In total, 422 NSTE-ACS patients with preserved renal function were enrolled to examine the association of cystatin C with MetS. MetS was defined based on the NCEP-ATP-III guidelines. Major adverse cardiovascular events (MACEs) were also evaluated, which included cardiac death, nonfatal myocardial infarction (MI), target vessel revascularization (TVR), heart failure, and nonfatal stroke. All patients underwent a 12-month follow-up for MACEs after admission.Results.Cystatin C was significantly correlated with metabolic risk factors and inflammation markers. The prevalence of MetS and MACEs correlated with cystatin C levels. Cystatin C showed a strong diagnostic performance for cardiovascular risk factors and outcomes in ROC analysis. After adjustment for multiple risk factors, cystatin C level was independently associated with MetS (OR 2.299, 95% CI 1.251–4.225, and P = 0.007). During a 12-month follow-up, the patients with high cystatin C level and MetS had higher incidence of MACEs (Log-rank = 24.586, P < 0.001) and cardiac death (Log-rank = 9.890, P = 0.020) compared to the others. Multivariate Cox analysis indicated that cystatin C level was an independent predictor of MACEs (HR 2.609, 95% CI 1.295–5.257, and P = 0.007).Conclusion.Cystatin C may be an independent predictor of metabolic syndrome and therefore valuable for management of NSTE-ACS patients. Further multicenter, large-scale studies are required to assess the implication of these results.

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.

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