Pheochromocytoma presenting as a mimic of acute coronary syndrome

Chest pain with elevated serum troponin is a common clinical presentation and is normally managed as suspected myocardial infarction or acute coronary syndrome (ACS). We report a 49 year old man who presented with central chest pain sweating and breathlessness. He had a significantly elevated serum troponin I level and a subsequent angiogram showed near normal coronary arteries. He was subsequently investigated for fever and found to have a 3cm right sided adrenal mass consistent with a pheochromocytoma. After confirmation and appropriate blockade laparoscopic adrenalectomy was performed. Pheochromocytoma may present as a mimic of acute coronary syndrome but this is often unrecognized and leaves the patient at risk of future pheo crisis events which may be fatal.

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Assessing the Performance of a Novel Point-of-Care Qualitative Assay for Early Diagnosis of Acute Coronary Syndrome

Cardiology ◽

10.1159/000511435 ◽

2020 ◽

pp. 1-8

Author(s):

Ronny Alcalai ◽

Boris Varshisky ◽

Ahmad Marhig ◽

David Leibowitz ◽

Larissa Kogan-Boguslavsky ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Diagnostic Accuracy ◽

Diagnostic Performance ◽

Troponin I ◽

Point Of Care ◽

Final Diagnosis ◽

Cardiac Biomarkers ◽

Fatty Acid Binding ◽

Coronary Syndrome

Background: Early and accurate diagnosis of acute coronary syndrome (ACS) is essential for initiating lifesaving interventions. In this article, the diagnostic performance of a novel point-of-care rapid assay (SensAheart©) is analyzed. This assay qualitatively determines the presence of 2 cardiac biomarkers troponin I and heart-type fatty acid-binding protein that are present soon after onset of myocardial injury. Methods: We conducted a prospective observational study of consecutive patients who presented to the emergency department with typical chest pain. Simultaneous high-sensitive cardiac troponin T (hs-cTnT) and SensAheart testing was performed upon hospital admission. Diagnostic accuracy was computed using SensAheart or hs-cTnT levels versus the final diagnosis defined as positive/negative. Results: Of 225 patients analyzed, a final diagnosis of ACS was established in 138 patients, 87 individuals diagnosed with nonischemic chest pain. In the overall population, as compared to hs-cTnT, the sensitivity of the initial SensAheart assay was significantly higher (80.4 vs. 63.8%, p = 0.002) whereas specificity was lower (78.6 vs. 95.4%, p = 0.036). The overall diagnostic accuracy of SensAheart assay was similar to the hs-cTnT (82.7% compared to 76.0%, p = 0.08). Conclusions: Upon first medical contact, the novel point-of-care rapid SensAheart assay shows a diagnostic performance similar to hs-cTnT. The combination of 2 cardiac biomarkers in the same kit allows for very early detection of myocardial damage. The SensAheart assay is a reliable and practical tool for ruling-in the diagnosis of ACS.

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Study of Cardiac Troponin I level in Acute Coronary Syndrome and its correlation with Left Ventricular Systolic Function

Cardiovascular Journal ◽

10.3329/cardio.v12i1.43415 ◽

2019 ◽

Vol 12 (1) ◽

pp. 24-29

Author(s):

Mohammad Jakir Hossain ◽

Khondoker Asaduzzaman ◽

Solaiman Hossain ◽

Muhammad Badrul Alam ◽

Nur Hossain

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Cardiac Troponin ◽

Troponin I ◽

Systolic Function ◽

Left Ventricular ◽

Cardiac Troponin I ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Coronary Syndrome

Background: In the diagnosis of acute coronary syndrome, cardiac troponin I is highly reliable and widely available biomarker. Serum level of cardiac troponin I is related to amount of myocardial damage and also closely relates to infarct size. Our aim of the study is to find out the relationship between cardiac troponin I and left ventricular systolic function after acute coronary syndrome. Methods: Total of 132 acute coronary syndrome patients were included in this study after admission in coronary care unit of Sir Salimullah Medical College, Mitford Hospital. Troponin I level was measured at admission and left ventricular ejection fraction (LVEF) was measured by echocardiography between 12-48 hours of onset of chest pain. Results: There was negative correlation between Troponin I at 12 to 48 hours of chest pain with LVEF in these study patients. With a cutoff value of troponin I e”6.8 ng/ml in STEMI patients there is a significant negative relation between 12 to 48 hrs troponin I and LVEF (p<0.001). Sensitivity of troponin I e” 6.8 ng/ml between 12 to 48 hours of chest pain in predicting LVEF <50% in STEMI was 93.75% and specificity was 77.78%. In NSTEMI sensitivity of troponin I e” 4.5 ng/ml between 12 to 48 hours of chest pain in predicting LVEF <50% was 65% and specificity was 54.05%. Conclusion: Serum troponin I level had a strong negative correlation with left ventricular ejection fraction after acute coronary syndrome and hence can be used to predict the LVEF in this setting. Cardiovasc. j. 2019; 12(1): 24-29

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P4689Comparison of high-sensitivity troponin T (hs-TnT) and high-sensitivity troponin I (hs-TnI) in the exclusion of acute coronary syndrome in patients with chest pain in the emergency department

European Heart Journal ◽

10.1093/eurheartj/ehx504.p4689 ◽

2017 ◽

Vol 38 (suppl_1) ◽

Author(s):

H.J.G. Tan ◽

S.H. Lim ◽

T.S.J. Chua ◽

A.S.L. Wong ◽

A.O. Sahlen ◽

...

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Troponin I ◽

Troponin T ◽

High Sensitivity ◽

Coronary Syndrome ◽

High Sensitivity Troponin ◽

High Sensitivity Troponin T

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Level of Serum Uric Acid Along with Other Demographic Parameters in Patients with Acute Coronary Syndrome : A Study of 55 Cases from Chittagong

Chattagram Maa-O-Shishu Hospital Medical College Journal ◽

10.3329/cmoshmcj.v13i2.21070 ◽

2014 ◽

Vol 13 (2) ◽

pp. 55-58

Author(s):

Hasan Murad ◽

Rajiv Dey ◽

Md Atiquel Islam Chowdhury ◽

Hridi Hedayet Ullah ◽

Md Abdur Rouf

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Uric Acid ◽

Unstable Angina ◽

Serum Uric Acid ◽

Troponin I ◽

Elevated Serum ◽

Common Finding ◽

Coronary Syndrome

The association between serum uric acid and ischemic heart disease remains controversial and it has been difficult to identify the specific role of elevated serum uric acid because of its association with established cardiovascular risk factors such as hypertension, diabetes mellitus, hyperlipidaemia and obesity. Our objective was to study the association of serum uric acid level with confirmed cases of Acute Coronary Syndrome i.e. Unstable Angina, Acute Myocardial Infarction(AMI). The study was conducted in Chittagong Medical College (CMC) & University of Science and Technology(USTC) and nearby diagnostic centre. The study was based on Patients with Acute Coronary Syndrome proved by ECG and/or raised serum Troponin I. The aim of the study was to determine the relationship between serum uric acid and Unstable angina or myocardial infacrtion. There were 35% males & 5% females. The mean age of respondent was 50 years and age ranges from 35 to 70 years. In this study 50 cases of diagnosed myocardial infarction were selected and subsequently investigated with ECG, Radiological and Echocardiographic investigations. Increased serum uric acid levels are a common finding in patients with high blood pressure, insulin resistance, obesity and Cardiovascular disease. The clinical findings, chest X-ray and ECG findings of patients with risk factors for myocardial infarction were extensively studied and the findings are consistent with findings stated in textbooks.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i2.21070

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Long-Term Experience With an Accelerated Protocol for Diagnosis of Chest Pain

Archives of Pathology & Laboratory Medicine ◽

10.5858/2000-124-1434-ltewaa ◽

2000 ◽

Vol 124 (10) ◽

pp. 1434-1439

Author(s):

Timothy E. Caragher ◽

Balbino B. Fernandez ◽

Lawrence A. Barr

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Troponin I ◽

Cost Savings ◽

Test Group ◽

Control Group ◽

Coronary Syndrome ◽

Diagnostic Sensitivity And Specificity ◽

Group B ◽

Accelerated Protocol

Abstract Context.—More than 6 million patients present annually with chest pain suggestive of acute coronary syndrome. Rapid and accurate diagnosis is essential for best clinical outcomes, for optimal management of hospital resources, and for minimizing medicolegal exposure. Objective.—To evaluate the clinical and cost outcomes of an accelerated protocol for chest pain triage in a community-based hospital of moderate size. Methods.—One hundred successive patients with chest pain were diagnosed according to the Traditional Chest Pain Protocol, which included testing of serial blood samples for creatine kinase (CK)-MB and total CK. These patients were also subjected to the Accelerated Chest Pain Protocol under evaluation, which included testing at shortened intervals for myoglobin and cardiac troponin I in addition to CK and CK-MB. Diagnostic sensitivity and specificity were compared versus the final assigned diagnosis. The Accelerated Chest Pain Protocol was implemented for routine use. Follow-up evaluations were conducted at 1 month (test group A, N = 180) and 22 months (test group B, N = 180). Costs for diagnosis and treatment of the 2 test groups were compared with those for the control group. Results.—The 2 protocols had equivalent specificity values (99%). The sensitivity of the Accelerated Chest Pain Protocol was higher than that of the Traditional Chest Pain Protocol (95% vs 58%). Cost savings of 29% and a reduction in length of stay of 33% were achieved in test group B versus the control group. Conclusions.—The Accelerated Chest Pain Protocol improved the accuracy and timeliness of diagnosis of acute coronary syndrome while reducing costs.

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Elevation of troponin values in differential diagnosis of chest pain in view of pulmonary thromboembolism

Vojnosanitetski pregled ◽

10.2298/vsp1210913v ◽

2012 ◽

Vol 69 (10) ◽

pp. 913-916 ◽

Cited By ~ 1

Author(s):

Rada Vucic ◽

Slavko Knezevic ◽

Zorica Lazic ◽

Olivera Andrejic ◽

Dragan Dincic ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Differential Diagnosis ◽

Heart Disease ◽

Chest Pain ◽

Muscle Injury ◽

Clinical Presentation ◽

Pulmonary Thromboembolism ◽

Coronary Syndrome ◽

Electrocardiographic Abnormalities ◽

D Dimer

Introduction. Acute coronary syndrome, as unstable form of ischaemic heart disease, beside clinical presentation and electrocardiographic abnormalities, is characterized by increased value of troponin one of cardiospecific enzimes. Although troponin is a high specific and sensitive indicator of acute coronary syndrome, any heart muscle injury may induce its increasing, so there are some other diseases with the increased troponin value. Case report. We presented a female patient with chest pain, admitted because of suspicioun of acute coronary sindrome. Performed coronarography excluded ischemic heart disease. Considering symtomatology, electrocardiographic abnormalities, increased troponin and D-dimer values, as well as echocardiography finding we considered pulmonary embolism as a differential diagnosis, which was confirmed by pulmoangiography. Conclusion. Isolated increased troponin values are not enough for diagnosis of acute coronary syndrome.

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Acute coronary syndrome is a common clinical presentation of in-stent restenosis

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(02)80185-1 ◽

2002 ◽

Vol 39 ◽

pp. 43

Author(s):

Darren Walters ◽

Scott Harding ◽

Craig Walsh ◽

Phillip Wong ◽

Eugene Pomerantsev ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Clinical Presentation ◽

Coronary Syndrome ◽

Stent Restenosis ◽

Common Clinical Presentation ◽

In Stent Restenosis

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Analytical performance and clinical application of a new rapid bedside assay for the detection of serum cardiac troponin I

Clinical Chemistry ◽

10.1093/clinchem/44.9.1925 ◽

1998 ◽

Vol 44 (9) ◽

pp. 1925-1930 ◽

Cited By ~ 41

Author(s):

Christopher Heeschen ◽

Britta U Goldmann ◽

Robert H Moeller ◽

Christian W Hamm

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Cardiac Troponin ◽

Troponin I ◽

Rapid Test ◽

Cardiac Troponin I ◽

Diagnostic Sensitivity ◽

Diagnostic Efficacy ◽

Coronary Syndrome ◽

Bedside Test

Abstract Detection of cardiac troponin I (cTnI) in patients suspected of having an acute coronary syndrome is highly predictive for an adverse outcome. We evaluated a bedside test for cTnI that uses a polyclonal capture antibody and two monoclonal indicator antibodies. Clinical studies were performed in patients with acute coronary syndrome and patients with chest pain but no evidence of acute myocardial injury. The whole-blood, 15-minute assay had a concordance of 98.9% with an ELISA for cTnI and a detection limit of 0.14 μg/L, and the device tolerated temperatures between 4 °C and 37 °C. Diagnostic sensitivity for myocardial infarction at arrival (3.5 ± 2.7 h after onset of symptoms) was 60% [creatine kinase isoenzyme MB (CK-MB) mass, 48%; CK activity, 36%; P < 0.01], and 4 h later, diagnostic sensitivity was 98% (CK-MB mass, 91%; CK activity, 61%; P < 0.01). In 38% of the patients with unstable angina, at least one positive cTnI test was found (CK-MB mass, 4%; CK activity, 2%). No false-positive test results were found in renal failure or injury of skeletal muscle. We conclude that the diagnostic efficacy of the cTnI rapid test was comparable with the cTnI ELISA and superior to CK-MB determination. Therefore, this device could facilitate decision-making in patients with chest pain at the point of care.

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