scholarly journals Fitting a Square Peg in a Round Hole: A Simple Case of Chest Pain

2020 ◽  
Vol 4 (1) ◽  
pp. 1-7
Author(s):  
Mary McLean ◽  
Jennifer Beck-Esmay
Keyword(s):  
Risk Factors ◽  
Chest Pain ◽  
Young Women ◽  
Point Of Care ◽  
Round Hole ◽  
Shortness Of Breath ◽  
Cardiac Enzymes ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Atherosclerotic Risk Factors

A 39-year-old female presents to the emergency department with chest pain and shortness of breath. Her electrocardiogram suggests ST-elevation myocardial infarction, but she has no atherosclerotic risk factors. She is gravida 4, para 4, and four weeks postpartum from uncomplicated vaginal delivery. She is diaphoretic and anxious, but otherwise her exam is unremarkable. Cardiac enzymes are markedly elevated and point-of-care echocardiogram shows inferolateral hypokinesis and ejection fraction of 50%. In this clinicopathological case, we explore a classically underappreciated cause of acute coronary syndrome in healthy young women.

scholarly journals Cardiac headache in acute coronary syndrome

2017 ◽  
Vol 4 (3) ◽  
pp. 21
Author(s):  
Phillip Tran ◽  
Robert Ziffra ◽  
Hoai V. Nguyen ◽  
Selena M. Losee
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Wide Distribution ◽  
Severe Headache ◽  
Coronary Risk Factors ◽  
Coronary Risk ◽  
Coronary Syndrome ◽  
St Elevation

Acute coronary syndrome may present in a wide distribution of symptoms. The classic presentation includes substernal chest pain, neck pain, dyspnea or syncope. In patients with coronary risk factors who present with headaches, acute coronary syndrome is rare, but has been previously reported. We describe a case of 63-year-old female who presented with a severe headache and developed a Non ST Elevation Myocardial Infarction.

scholarly journals Effect of a Triage‐Based Screening Protocol on Diagnosis and Treatment of Acute Coronary Syndrome in a Tanzanian Emergency Department: A Prospective Pre‐Post Study

2020 ◽  
Vol 9 (16) ◽  
Author(s):  
Julian T. Hertz ◽  
Francis M. Sakita ◽  
Godfrey L. Kweka ◽  
Gerald S. Bloomfield ◽  
John A. Bartlett ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Troponin I ◽  
Point Of Care ◽  
Sub Saharan Africa ◽  
Shortness Of Breath ◽  
Coronary Syndrome ◽  
Screening Protocol ◽  
Sub Saharan ◽  
Research Assistants

Background Evidence suggests that acute coronary syndrome (ACS) is underdiagnosed in sub‐Saharan Africa. Triage‐based interventions have improved ACS diagnosis and management in high‐income settings but have not been evaluated in sub‐Saharan African emergency departments (EDs). Our objective was to estimate the effect of a triage‐based screening protocol on ACS diagnosis and care in a Tanzanian ED. Methods and Results All adults presenting to a Tanzanian ED with chest pain or shortness of breath were prospectively enrolled. Treatments and clinician‐documented diagnoses were observed and recorded. In the preintervention phase (August 2018 through January 2019), ACS testing and treatment were dictated by physician discretion, as per usual care. A triage‐based protocol was then introduced, and in the postintervention phase (January 2019 through October 2019), research assistants performed ECG and point‐of‐care troponin I testing on all patients with chest pain or shortness of breath upon ED arrival. Pre‐post analyses compared ACS care between phases. Of 1020 total participants (339 preintervention phase, 681 postintervention phase), mean (SD) age was 58.9 (19.4) years. Six (1.8%) preintervention participants were diagnosed with ACS, versus 83 (12.2%) postintervention participants (odds ratio [OR], 7.51; 95% CI, 3.52–19.7; P <0.001). Among all participants, 3 (0.9%) preintervention participants received aspirin, compared with 50 (7.3%) postintervention participants (OR, 8.45; 95% CI, 3.07–36.13; P <0.001). Conclusions Introduction of a triage‐based ACS screening protocol in a Tanzanian ED was associated with significant increases in ACS diagnoses and aspirin administration. Additional research is needed to determine the effect of ED‐based interventions on ACS care and clinical end points in sub‐Saharan Africa.

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

Cardiology ◽  
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

<b><i>Background:</i></b> 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<sup>©</sup>) 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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%, <i>p</i> = 0.002) whereas specificity was lower (78.6 vs. 95.4%, <i>p</i> = 0.036). The overall diagnostic accuracy of SensAheart assay was similar to the hs-cTnT (82.7% compared to 76.0%, <i>p</i> = 0.08). <b><i>Conclusions:</i></b> 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.

scholarly journals Elevated troponin and left bundle branch block in the setting of suspected septicemia and demand ischemia: to treat or not to treat

2018 ◽  
Author(s):  
Munish Sharma ◽  
Rubinder Toor ◽  
Koroush Khalighi
Keyword(s):  
Chest Pain ◽  
Left Bundle Branch Block ◽  
Cardiac Monitoring ◽  
Type Ii ◽  
Elevated Troponin ◽  
Cardiac Enzymes ◽  
Atypical Chest Pain ◽  
Bundle Branch Block ◽  
Coronary Catheterization ◽  
St Elevation

Elevated troponin and atypical chest pain in the setting of septicemia and Type II Non ST elevation myocardial infarction is frequently encountered. These cases are not necessarily scheduled for emergent cardiac catheterization. High index of clinical suspicion and continuous in-patient cardiac monitoring with serial trending of cardiac enzymes are important in such cases. Subsequent sudden development of electrocardiogram changes requires prompt investigation with emergent coronary catheterization. These types of cases may be missed especially in females who present with atypical chest pain and in patients with Left bundle branch block.

scholarly journals Meningococcemia Presenting as a Myocardial Infarction

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Daniel Lachant ◽  
David Trawick
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Chest Pain ◽  
Cardiogenic Shock ◽  
Neisseria Meningitidis ◽  
Early Recognition ◽  
Myocardial Dysfunction ◽  
Shortness Of Breath ◽  
Gram Negative ◽  
St Elevation

Neisseria meningitidisis an encapsulated gram negative diplococcus that colonizes the nasopharynx and is transmitted by aerosol or secretions with the majority of cases occurring in infants and adolescents. Meningococcemia carries a high mortality which is in part due to myocarditis. Early recognition and prompt use of antibiotics improve morbidity and mortality. We report a 55-year-old male presenting to the emergency department with chest pain, shortness of breath, and electrocardiogram changes suggestive of ST elevation MI who developed cardiogenic shock and multisystem organ failure fromN. meningitidis. We present this case to highlight the unique presentation of meningococcemia, the association with myocardial dysfunction, and the importance of early recognition and prompt use of antibiotics.

Integrating point-of-care ultrasound in the ED evaluation of patients presenting with chest pain and shortness of breath

2019 ◽  
Vol 37 (2) ◽  
pp. 298-303 ◽  
Author(s):  
Rasha E. Buhumaid ◽  
Julie St-Cyr Bourque ◽  
Hamid Shokoohi ◽  
Irene W.Y. Ma ◽  
Mckenna Longacre ◽  
...  
Keyword(s):  
Chest Pain ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Shortness Of Breath

scholarly journals Acute Coronary Syndrome in Pregnancy

2009 ◽  
Vol 3 ◽  
pp. CMC.S3284 ◽  
Author(s):  
Douglas Wright ◽  
Claire Kenny-Scherber ◽  
Alison Montgomery ◽  
Omid Salehian
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Present Report ◽  
Rare Event ◽  
Physiological Changes ◽  
Coronary Syndrome ◽  
Incidence Risk ◽  
St Elevation ◽  
In Pregnancy

Acute coronary syndrome (ACS) in pregnancy has traditionally been considered to be a rare event, but the combination of normal physiological changes of pregnancy and more prevalent cardiovascular risk factors are increasing its incidence in this population. The present report describes a 39 year-old woman that is seven weeks pregnant presenting with a non ST elevation myocardial infarction. The incidence, risk factors, pathophysiology and management of ACS in pregnancy are discussed.

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