scholarly journals Pulmonary embolism in the COVID-19 pandemic era: Importance of bedside electrocardiography, echocardiography and use of Tenecteplase.

2021 ◽  
Vol 10 (1) ◽  
pp. 9-15
Author(s):  
O.F. Nwako ◽  
C.A. Nwako ◽  
C.N. Nwako ◽  
A.B. Nwako
Keyword(s):  
Myocardial Infarction ◽  
Pulmonary Embolism ◽  
Chest Pain ◽  
Pulmonary Arteries ◽  
Sudden Onset ◽  
Daily Activities ◽  
Productive Cough ◽  
Diagnostic Challenge ◽  
Antithrombotic Agent ◽  
The Third

Pulmonary embolism is a blockage in one of the pulmonary arteries in the lungs. Globally, it is the third most frequent acute cardiovascular syndrome behind myocardial infarction and stroke. This is a 43-yearold Nigerian diabetic man who had liposuction three weeks before presenting with sudden onset breathlessness, productive cough, chest pain, fever, inability to complete a sentence and inability to carry out his normal daily activities during this coronavirus 2019 (COVID-19) pandemic. He was tachypneic, tachycardic, hypotensive with rapidly dropping oxygen saturation (84%-86%, 80%-84%). This presented a diagnostic challenge which was rapidly resolved with bedside electrocardiography and echocardiography. A diagnosis of pulmonary embolism was sustained. Subsequent SARS-COV-2 PCRbased test was negative. He was successfully managed with an antithrombotic agent, tenecteplase, without any adverse events. Keywords: COVID-19, pulmonary embolism, tenecteplase, electrocardiography, echocardiography

scholarly journals Spontaneous Sternal Fracture — A Misnomer

1986 ◽  
Vol 79 (3) ◽  
pp. 175-176 ◽  
Author(s):  
R C Bowyer ◽  
V L R Touquet
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Pulmonary Embolism ◽  
Chest Pain ◽  
Sudden Onset ◽  
Sternal Fracture ◽  
Uncomplicated Case ◽  
Accident And Emergency ◽  
Accident And Emergency Department ◽  
Sternal Fractures

Spontaneous sternal fractures, although rare, may present to the Accident and Emergency Department as a severe central chest pain of sudden onset. These may be confused with myocardial infarction1 or pulmonary embolism2. Treatment in the uncomplicated case may be symptomatic with analgesics, but this fracture may require sternal wiring if paradoxical sternal movement embarrasses respiration. Spontaneous fracture of the sternum appears in the majority of cases to be due either to secondary metastatic infiltration, myelomatosis or extreme osteoporosis3. We report a case which emphasizes the importance of investigating these patients.

scholarly journals Rare Case of Cocaine-Induced Aortic Aneurysm: A Near Dissection Event

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Ranju Kunwor ◽  
AnnMarie Canelas
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Coronary Artery Spasm ◽  
Wall Stress ◽  
Sudden Onset ◽  
Clinical Feature ◽  
Cocaine Use ◽  
Common Presentation

Cocaine use has been associated with cardiovascular complications such as coronary atherosclerosis, coronary artery spasm, cardiac arrhythmias, acute myocardial infarction, myocarditis, and dilated cardiomyopathies. Aortic dissection is a rare but life-threatening complication of cocaine use. Cocaine and stimulant use can cause aortic aneurysm by increasing the aortic wall stress, and the most feared complications are dissection, rupture, and death. There are no clear guidelines about screening cocaine abusers with CT scan of the chest. We do not know if the number of years of cocaine use or the amount of cocaine use can be associated with higher incidence of aortic aneurysm or dissection. Cocaine-induced aortic aneurysm does not have any specific clinical feature. Common presentation is chest discomfort or chest pain. This common presentation is bewildering enough for clinicians to think of more common causes of chest pain like myocardial infarction and myocarditis. The sudden onset of severe, sharp, stabbing chest or back pain is suggestive of aortic dissection. Here, we present a young otherwise healthy patient with chronic cocaine use presenting with chest pain and found to have significant size aortic aneurysm.

Activity of serum aspartate aminotransferase isoenzymes in patients with acute myocardial infarction.

1987 ◽  
Vol 33 (1) ◽  
pp. 67-71 ◽  
Author(s):  
M Panteghini ◽  
F Pagani ◽  
C Cuccia
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Creatine Kinase ◽  
Chest Pain ◽  
Aspartate Aminotransferase ◽  
Biological Information ◽  
Serum Samples ◽  
The Third ◽  
Serum Aspartate Aminotransferase ◽  
Serial Serum

Abstract Activities of aspartate aminotransferase (AST) isoenzymes were determined in serial serum samples from 40 cases of acute myocardial infarction, and compared with activities of creatine kinase, CK-MB isoenzyme, lactate dehydrogenase, and alpha-hydroxybutyrate dehydrogenase for temporal changes. Cytosolic (soluble) AST (s-AST) and mitochondrial AST (m-AST) respectively increased 6.6 and 9.0 h after onset of chest pain. The median time at which serum m-AST activity peaked (15.8 U/L, range 6.4-53.5 U/L) was 47.8 h after the onset of infarction, 19.8 h later than the peak s-AST activity (171 U/L, range 53-517 U/L) and m-AST also disappeared from the serum more slowly than s-AST (p less than 0.001). Serum m-AST values were above normal for at least six days after the infarct. The ratio of m-AST to total AST in serum increased after myocardial infarction, being greatest (20%, range 11-32%) on the third day after onset. For individuals, peak activities of s-AST correlated well with total CK (r = 0.91) and CK-MB (r = 0.86) peak activities, indicating that s-AST also reflects the infarct size. However, m-AST correlated poorly with the enzymes commonly used in infarct diagnosis; it apparently provides different biological information.

Approach to the Patient Presenting with Chest Pain

2017 ◽  
Author(s):  
John Tobias Nagurney
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Pulmonary Embolism ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Pain History

Caring for the emergency department patient with chest pain represents an important challenge to the emergency physician. Chest pain is the second most common presentation among all emergency department patients, accounting for approximately 6 million visits per year in the United States. Chest pain may represent a benign condition or a time-critical life threat; symptom overlap between benign and serious conditions can make an accurate chest pain diagnosis challenging. This review covers the pathophysiology, assessment, stabilization, diagnosis and treatment, and disposition and outcomes of chest pain. The figure shows an algorithm outlining the approach to the patient with chest pain. Tables list critical and noncritical diagnoses in patients presenting with chest pain: history, physical examination, and bedside testing; risk factors or associations for acute coronary syndrome, pulmonary embolism, and aortic dissection; characteristics of the chest pain story to diagnose acute coronary syndrome; ABCDEs of resuscitation for patients with unstable vital signs; critical and noncritical diagnoses in patients presenting with chest pain: history, diagnosis, and treatment; prevalence of pulmonary embolism in patients classified as low or high probability for this diagnosis by Wells score, modified Geneva score, and gestalt; commonly recognized pitfalls in the workup and diagnosis of chest pain in the emergency department; critical diagnoses in patients presenting with chest pain: history, disposition, and outcome; and summary of current recommendations. This review contains 1 highly rendered figure, 11 tables, and 54 references. Key words: acute coronary syndrome, acute myocardial infarction, anginal pain, aortic dissection, cardiac-related pain, chest pain, coronary artery disease, non–ST segment elevation myocardial infarction, pulmonary embolism, ST segment elevation myocardial infarction

Acute Pericardial Fat Necrosis

2010 ◽  
pp. 305-308
Author(s):  
Edward C. Rosenow
Keyword(s):  
Myocardial Infarction ◽  
Pulmonary Embolism ◽  
Differential Diagnosis ◽  
Chest Pain ◽  
Fat Necrosis ◽  
Pleuritic Chest Pain ◽  
Pericardial Fat

• Mostly left-sided • Affects females more than males • Acute severe pleuritic chest pain ∘ Differential diagnosis • Myocardial infarction • Pericarditis • Pulmonary embolism • Obesity may or may not be present • On CT, necrosis produces irregularity mimicking neoplasm but also fat density...

scholarly journals Situs Inversus: Inferior-Lateral ST-Elevation Myocardial Infarction on Right-Sided Electrocardiogram

2019 ◽  
Vol 3 (3) ◽  
pp. 307-309
Author(s):  
Mohamed Hamam ◽  
Howard Klausner
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Health Risks ◽  
St Elevation Myocardial Infarction ◽  
Diagnostic Challenge ◽  
Coronary Syndrome ◽  
Anatomical Anomaly ◽  
Syndrome Diagnosis ◽  
St Elevation ◽  
The Right

Dextrocardia is a rare anatomical anomaly in which the heart is located in the patient’s right hemithorax with its apex directed to the right. Although it usually does not pose any serious health risks, patients with undiagnosed dextrocardia present a diagnostic challenge especially in those presenting with chest pain. Traditional left-sided electrocardiograms (ECG) inadequately capture the electrical activity of a heart positioned in the right hemithorax, which if unnoticed could delay or even miss an acute coronary syndrome diagnosis. Here, we present a case of a patient with dextrocardia presenting with chest pain and diagnosed with ST-elevation myocardial infarction using a right-sided ECG.

scholarly journals Physical exercise and Sport activities in patients with and without coronary heart disease

2016 ◽  
Vol 68 (2) ◽  
Author(s):  
Giuseppe Francavilla ◽  
Maurizio Giuseppe Abrignani ◽  
Annabella Braschi ◽  
Rosalba Sciacca ◽  
Vincenzo Christian Francavilla ◽  
...  
Keyword(s):  
Physical Activity ◽  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Chest Pain ◽  
Average Distance ◽  
Lower Percentage ◽  
Coronary Risk ◽  
The Third ◽  
Chronic Heart Disease

Background: The quantity and intensity of physical activity required for the primary prevention of coronary heart disease remain unclear. Therefore, we examined the association between physical activity and coronary risk. Methods: We studied 100 patients with chest pain, 78 men and 22 women, not older than 65 years, admitted to a coronary care unit. Patients were subdivided in 3 groups: the first group included patients with acute myocardial infarction, the second group included patients with chronic heart disease, the third included patients with non-ischemic chest-pain. A questionnaire on daily physical activity was filled by each patient. Results: A significantly higher percentage of patients with myocardial infarction and coronary heart disease had a sedentary life style compared to patients of the third group. Compared with subjects without heart disease, a significantly higher percentage of patients of the first and second group covered a daily average distance shorter than 500 meters, while a significantly inferior percentage covered a distance longer than 1 Km every day. A significantly lower percentage of patients with coronary heart disease practised sport compared with the third group. At the time of hospitalization a very small percentage of coronary heart disease patients still practised sport. Conclusions: The association between physical activity and reduced coronary risk is clear; in order to obtain benefits it is sufficient just walking every day. Regarding physical activity, continuity is important: patients, who practised sport only in juvenile age, breaking off when older, may lose the obtained advantages.

scholarly journals Concomitant acute myocardial infarction and acute pulmonary embolism caused by paradoxical embolism: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Weiwei Chen ◽  
Zhixi Yu ◽  
Siming Li ◽  
Kenji Wagatsuma ◽  
Beibei Du ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Pulmonary Arteries ◽  
Acute Chest Pain ◽  
Paradoxical Embolism ◽  
Multiple Imaging ◽  
Low Incidence

Abstract Background Due to its low incidence and diverse manifestations, paradoxical embolism (PDE) is still under-reported and is not routinely considered in differential diagnoses. Concomitant acute myocardial infarction (AMI) and acute pulmonary embolism (PE) caused by PDE has rarely been reported. Case presentation A 45-year-old woman presented with acute chest pain and difficulty with breathing. Multiple imaging modules including ECG, echocardiography, emergency cardioangiogram (CAG), and CT angiography of the pulmonary arteries showed acute occlusion of the posterolateral artery and acute PE. After coronary aspiration, no residual stenosis was observed. One month later, a bubble study showed inter-atrial communication via a patent foramen ovale (PFO). The AMI in this patient was finally attributed to PDE via the PFO. PFO closure was performed, and long-term anticoagulation was prescribed to prevent recurrent thromboembolic events. Conclusions PDE via PFO is a rare etiology of AMI, especially in patients with concomitant AMI and PE. Clinicians should be vigilant of this possibility and close the inter-atrial channel for secondary prevention.

scholarly journals Pulmonary Embolism presenting as Syncope

2015 ◽  
Vol 12 (1) ◽  
pp. 37-41
Author(s):  
Dipak Mall ◽  
Yang Shaning
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Pulmonary Embolism ◽  
Differential Diagnosis ◽  
Chest Pain ◽  
Cardiac Care ◽  
Appropriate Treatment

The diagnosis of Pulmonary embolism can easily be missed if it is not considered as one of the major differential diagnosis in a case of syncope without chest pain. We describe a case of a 74years old female with pulmonary embolism induced syncope, which highlights one of the difficulties in diagnosing pulmonary embolism. In a patient presenting in syncope without chest pain but raised troponin, the possibility of pulmonary embolism should also be considered if it does not fit with myocardial infarction. Otherwise, the diagnosis can be easily missed and patients may not receive appropriate treatment resulting in increased mortality. Pulmonary embolism should be considered in the differential diagnosis of every syncopal event in Emergency department and Cardiac care units. DOI: http://dx.doi.org/10.3126/njh.v12i1.12343 Nepalese Heart Journal Vol.12(1) 2015: 37-41

scholarly journals A Rare Case of Pulmonary Embolism: A Case Report

2019 ◽  
Vol 2 (1) ◽  
pp. 105-109
Author(s):  
Tirtha Man Shrestha ◽  
Ram Neupane ◽  
Bandana Neupane ◽  
Reeju Manandhar
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Chest Pain ◽  
Lung Diseases ◽  
Troponin I ◽  
Sudden Onset ◽  
Coagulation Disorder ◽  
Coronary Syndrome ◽  
Doppler Study ◽  
History Of

Pulmonary embolism in an old patient with a history of coagulation disorder, any recent major surgeries or in a chronic heart or lung diseases is widely reported. Also, a recent history of travel by air with flight distance of more than 5000km or BMI greater than 35 kg/m2 increase risk. However, we report here, a suggestive case of acute pulmonary embolism in a previously well male of 38 years, with a BMI of 25.71kg/m2 without any history of chronic illness or acute exacerbations. The patient presented in health facility with sudden onset of radiating chest pain and some other nonspecific symptoms. Neither any other significant personal risk factors except smoking, nor any family history of heart/lung diseases were ruled out during initial assessments. On investigations, other routine examinations were normal but T-wave inversion was noticed in lead V1-4 in ECG, Troponin-I was positive and CPK-MB was slightly elevated (27 U/L). Furthermore, no any remarkable changes were noticed in Chest X-ray. Then, the patient was referred to higher center with cardiac facility with provisional diagnosis of Acute Coronary Syndrome for further evaluation and management. Thereupon, Coronary Angiogram (CAG) was done and the report was normal but echocardiography findings were suggestive of pulmonary Embolism. D-dimer was also elevated (8279.05 ng/ml) but venous doppler study of bilateral lower limb was normal. Finally, CT-PA showed partially occluding thrombus in main pulmonary bifurcation extending into left and right pulmonary artery, its bilateral segmental branches and calcified granuloma was seen in right lobe of liver. Patient was under inj. LMWH and other supportive management during hospitalization. After an uneventful hospital stay for 12 days, general condition was improved and eventually, patient was discharged, with oral warfarin. Keywords: chest pain; Nepal; pulmonary embolism; risk factors.

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