Acute migraine attack, angina-like chest pain with documented ST-segment elevation and slow coronary flow

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.

Download Full-text

Acute Pericarditis after Percutaneous Coronary Intervention: A Case Report

Medicina ◽

10.3390/medicina57050490 ◽

2021 ◽

Vol 57 (5) ◽

pp. 490

Author(s):

Greta Rodevič ◽

Povilas Budrys ◽

Giedrius Davidavičius

Keyword(s):

Percutaneous Coronary Intervention ◽

Chest Pain ◽

Troponin I ◽

Stable Condition ◽

Coronary Intervention ◽

Prior History ◽

Acute Pericarditis ◽

St Segment Elevation ◽

St Segment ◽

Percutaneous Coronary

Background: Percutaneous coronary intervention (PCI) is known as a very rare possible trigger of pericarditis. Most frequently it develops after a latent period or early in the case of periprocedural complications. In this report, we present an atypical early onset of pericarditis after an uncomplicated PCI. Case Summary: A 58-year-old man was admitted to the hospital for PCI of the chronic total occlusion of the left anterior descending (LAD) artery. An initial electrocardiogram (ECG) was unremarkable. The PCI attempt was unsuccessful. There were no procedure-related complications observed at the end of the PCI attempt and the patient was symptom free. Six hours after the interventional procedure, the patient complained of severe chest pain. The ECG demonstrated ST-segment elevation in anterior and lateral leads. Troponin I was mildly elevated but a coronary angiogram did not reveal the impairment of collateral blood flow to the LAD territory. Due to pericarditic chest pain, typical ECG findings and pericardial effusion with elevated C-reactive protein, the diagnosis of acute pericarditis was established, and a course of nonsteroidal anti-inflammatory drugs (NSAIDs) was initiated. Chest pain was relieved and ST-segment elevation almost completely returned to baseline after three days of treatment. The patient was discharged in stable condition without chest pain on the fourth day after symptom onset. Conclusions: Acute pericarditis is a rare complication of PCI. Despite the lack of specific clinical manifestation, post-traumatic pericarditis should be considered in patients with symptoms and signs of pericarditis and a prior history of iatrogenic injury or thoracic trauma.

Download Full-text

Fogarty Maneuver to Restore Coronary Flow in ST-Segment Elevation Myocardial Infarction

American Journal of Therapeutics ◽

10.1097/mjt.0000000000000322 ◽

2016 ◽

Vol 23 (5) ◽

pp. e1234-e1238 ◽

Cited By ~ 1

Author(s):

Mark J. Larralde ◽

Ashwad Afzal ◽

Sorin J. Brener

Keyword(s):

Myocardial Infarction ◽

Coronary Flow ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

Download Full-text

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

International Journal of Cardiology ◽

10.1016/s0167-5273(03)00082-2 ◽

2003 ◽

Vol 92 (2-3) ◽

pp. 193-199 ◽

Cited By ~ 9

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

Download Full-text

Treatment of Acute Migraine Attack With Diclofenac Sodium: A Double-Blind Study

Headache The Journal of Head and Face Pain ◽

10.1111/j.1526-4610.1992.hed3202098.x ◽

1992 ◽

Vol 32 (2) ◽

pp. 98-100 ◽

Cited By ~ 24

Author(s):

George N. Karachalios ◽

Adroniki Fotiadou ◽

Nickolaos Chrisikos ◽

Alexandros Karabetsos ◽

Kyriakos Kehagioglou

Keyword(s):

Migraine Attack ◽

Diclofenac Sodium ◽

Blind Study ◽

Double Blind Study ◽

Acute Migraine ◽

Double Blind ◽

Acute Migraine Attack

Download Full-text

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

Circulation ◽

10.1161/circ.142.suppl_3.15848 ◽

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.

Download Full-text