A rare case of acute alcohol intoxication mimicking an electrocardiographic pattern for acute coronary syndrome with ST-segment elevation

A patient presenting an ST-segment elevation could represent a life-threatening condition in Emergency Department (ED). This case shows how sometimes, a chronic, and more often, an acute abuse of alcohol is related to important harmful effects on myocardial contractility. The authors present a case of a 19-year-old male of oriental-Asiatic origin admitted unconscious to ED with alcoholic fetor: on electrocardiogram a significant and widespread STsegment elevation was observed. A bedside echocardiography showed no abnormalities in segmental kinetics; therefore electrocardiogram- alterations could be related to a coronary spasm. The literature is poor about this effect induced by acute alcohol ingestion: the pathophysiological mechanism at the base of the abnormal muscle contractility, seems to be related to an impairment in cyclic guanosine monophosphate production, although a second and less probable hypothesis could be an altered intracellular concentration of calcium levels.

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Management of ST Elevation Myocardial Infarction (STEMI) in Different Settings

International Journal of Angiology ◽

10.1055/s-0041-1723944 ◽

2021 ◽

Author(s):

Rod Partow-Navid ◽

Narut Prasitlumkum ◽

Ashish Mukherjee ◽

Padmini Varadarajan ◽

Ramdas G. Pai

Keyword(s):

Myocardial Infarction ◽

Treatment Strategies ◽

Management Process ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

Multiple Factors ◽

St Segment ◽

Threatening Condition ◽

Life Threatening ◽

St Elevation

AbstractST-segment elevation myocardial infarction (STEMI) is a life-threatening condition that requires emergent, complex, well-coordinated treatment. Although the primary goal of treatment is simple to describe—reperfusion as quickly as possible—the management process is complicated and is affected by multiple factors including location, patient, and practitioner characteristics. Hence, this narrative review will discuss the recommended management and treatment strategies of STEMI in the circumstances.

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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

10.21203/rs.2.24315/v1 ◽

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.

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Lithium-induced ECG modifications: navigating from acute coronary syndrome to Brugada syndrome

BMJ Case Reports ◽

10.1136/bcr-2021-241555 ◽

2021 ◽

Vol 14 (6) ◽

pp. e241555

Author(s):

Léonard Diserens ◽

Alessandra Pia Porretta ◽

Catalina Trana ◽

David Meier

Keyword(s):

Brugada Syndrome ◽

Bipolar Disorders ◽

Therapeutic Modality ◽

St Segment Elevation ◽

Coronary Syndrome ◽

Frequent Monitoring ◽

St Segment ◽

Life Threatening ◽

Ecg Alterations

Lithium is frequently used in the treatment of bipolar disorders and is known to induce ECG alterations. This case study describes various patterns of lithium-induced ECG modifications in a patient with acute-on-chronic lithium intoxication. Clinicians should be familiar with this problem as it can have life-threatening consequences and lead to important changes in patient’s management. Our patient was admitted for acute delirium with an ECG showing atrial fibrillation with wide QRS and ST-segment elevation. These modifications were first mistaken for an acute myocardial infarction and a diagnosis of Brugada syndrome was finally reached. Treatment after the acute phase implied changes in the therapeutic modality and required frequent monitoring.

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Metamizole-Induced Type I Kounis Syndrome

European Journal of Case Reports in Internal Medicine ◽

10.12890/2021_002249 ◽

2021 ◽

Author(s):

Catarina Lameiras ◽

Ana Corte-Real ◽

Ana Órfão ◽

Marta Mendes Lopes ◽

Maria do Céu Dória

Keyword(s):

Previous History ◽

Clinical Manifestations ◽

Type I ◽

Kounis Syndrome ◽

St Segment Elevation ◽

Acute Urticaria ◽

Coronary Syndrome ◽

St Segment ◽

Life Threatening ◽

Cardiac Manifestations

Kounis syndrome (KS) is defined as acute coronary syndrome (ACS) triggered by mast cell and platelet activation in the setting of allergic or anaphylactic insults. KS is a unique and complex cause of ACS and many cases may be missed due to its highly variable clinical manifestations. In this report, we present a case of KS type I triggered by metamizole in the absence of a previous history of allergy to this drug. Following the administration of metamizole, the patient developed generalized acute urticaria, chest pain and diaphoresis. Electrocardiography (ECG) showed ST-segment elevation suggestive of myocardial infarction complicated by ventricular tachycardia. No coronary disease was observed on coronary angiography. The cardiac manifestations of KS may be life-threatening, and so it is important to appropriately recognize and treat this condition.

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Kounis Syndrome Secondary to Medicine-Induced Hypersensitivity

Case Reports in Medicine ◽

10.1155/2021/4485754 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Parackrama Karunathilake ◽

Udaya Ralapanawa ◽

Thilak Jayalath ◽

Shamali Abeyagunawardena

Keyword(s):

Allergic Reaction ◽

Troponin I ◽

Complete Recovery ◽

Isosorbide Mononitrate ◽

Kounis Syndrome ◽

Coronary Syndrome ◽

St Segment ◽

Daily Dose ◽

Threatening Condition ◽

Life Threatening

Introduction. Kounis syndrome is the concurrence of an acute coronary syndrome (ACS) caused by coronary vasospasms, acute myocardial infarctions, or stent thromboses in case of allergic or hypersensitivity reactions. Kounis syndrome is mediated by mast cells that interact with macrophages and T-lymphocytes, causing degranulation and inflammation with cytokine release. It is a life-threatening condition that has many trigger factors and is most commonly caused by medicines. Case Presentation. A 71-year-old male was admitted with a fever of five days’ duration associated with cellulitis, for which he had been treated with clindamycin and flucloxacillin before admission. He was a diagnosed patient with hypertension and dyslipidemia five years ago. After taking the antibiotics, he had developed generalized itching followed by urticaria suggesting an allergic reaction. Therefore, he was admitted to the hospital. After admission, he developed an ischaemic-type chest pain associated with autonomic symptoms and shortness of breath. An immediate ECG was taken that showed ST-segment depressions in the chest leads V4–V6, confirmed by a repeat ECG. Troponin I was 8 ng/mL. Acute management of ACS was started, and prednisolone 10 mg daily dose was given. After complete recovery, the patient was discharged with aspirin, clopidogrel, atorvastatin, metoprolol, losartan, isosorbide mononitrate, and nicorandil. Prednisolone 10 mg daily dose was given for five days after discharge. Conclusion. In immediate hypersensitivity, with persistent cardiovascular instability, Kounis syndrome should be considered, and an electrocardiogram and other appropriate assessments and treatments should be initiated. Prompt management of the allergic reaction and the ACS is vital for a better outcome of Kounis syndrome.

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Recurrent diclofenac-induced acute myocardial infarction: An interesting case with wandering ST-segment elevation

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907919845526 ◽

2019 ◽

Vol 27 (5) ◽

pp. 304-307

Author(s):

Emre Özdemir ◽

Zeynep Karakaya ◽

Mustafa Karaca ◽

Fatih Topal ◽

Umut Payza

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Antiplatelet Agent ◽

Coronary Spasm ◽

Interesting Case ◽

Allergic Reactions ◽

Anterior Myocardial Infarction ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment

Introduction: Allergic acute myocardial infarction with ST-segment elevation is rare, and vasoconstrictor mediators released from mast cells are responsible for its pathogenesis. Several medications have been reported to lead to acute myocardial infarction with ST-segment elevation, as a part of systemic allergic reactions and this entity is known as Kounis syndrome (KS). Case presentation: We presented a patient with recurrent KS who had no allergic reactions, except coronary spasm after parenteral diclofenac administration. First, she experienced anterior myocardial infarction with ST-segment elevation after administration of diclofenac 2 years ago. The second presentation was acute inferior-posterior myocardial infarction with ST-segment elevation with atrioventricular complete block leading to cardiogenic shock. She had no significant coronary stenosis responsible for each myocardial infarction with ST-segment elevation. However, she had a catheter-induced coronary spasm of non-dominant right coronary artery. She was considered to have a recurrent allergic myocardial infarction with ST-segment elevation due to parenteral diclofenac usage and treated with a calcium antagonist, statin, and dual antiplatelet agent. Discussion: KS can manifest as same as acute coronary syndrome. All drugs or any allergen can cause this event.KS had three variants but In all three conditions, treatment is antithrombotic or vasodilatator regime. Conclusion: As atherosclerosis events on coronary, allergic coronary events also may recurs. However, unlike the literature, our case is differentiated by recurrence of similar events in different coronary vessels.

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