scholarly journals To Perform Thrombolysis or Not: A Case of Acute Pancreatitis Presenting with Chest Pain and Transient Left Bundle Branch Block

2010 ◽  
Vol 2010 ◽  
pp. 1-3 ◽  
Author(s):  
S. Ullah ◽  
S. Mehmood ◽  
H. A. Chatha ◽  
A. Mahmood
Keyword(s):  
Acute Pancreatitis ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Serum Amylase ◽  
Suspected Case ◽  
Ecg Changes ◽  
Bundle Branch Block ◽  
Coronary Syndrome ◽  
Laboratory Results ◽  
New Onset

A suspected case of acute coronary syndrome presented with new-onset left bundle branch and first-degree heart blocks. The decision to thrombolyse was reverted as ECG changes proved to be transient within fifteen minutes of presentation. Later on the patient was diagnosed with acute pancreatitis based on laboratory results of serum amylase, confirmed on radiological investigations.

scholarly journals Alternating Bundle Branch Block or Pyridostigmine-induced Mobitz Type II Block Masquerading as Acute Coronary Syndrome

2020 ◽  
Vol 3 (2) ◽  
pp. 63-66
Author(s):  
Ashima Sharma ◽  
Akula Hymavathi ◽  
Sarat C Uppaluri
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Acute Ischemia ◽  
Type Ii ◽  
Ecg Changes ◽  
Bundle Branch Block ◽  
Coronary Syndrome ◽  
Bundle Branch Blocks ◽  
Artery Disease ◽  
Mobitz Type

ABSTRACT Background “ST-T changes in the ECG!!” These words are enough to get the emergency doctor to spring into action. These changes can be diffuse and/or non-specific but we should rule out all emergent and urgent causes before shifting the patient to the specialist. To err on the side of dangerous etiology is the dictum. Introduction Out of all emergency department (ED) patients with undifferentiated chest pain, 7% will have ECG findings consistent with acute ischemia or infarction, and 6–10% of those in whom cardiac markers are ordered will have initially positive results. Of all patients with the possible acute coronary syndrome (ACS), 5–15% ultimately prove to have ACS.1 Shortness of breath with chest pain mostly has a cardiac origin in the presence of dynamic ECG changes. We had managed a patient with rapidly evolving ECG changes, chest pain, palpitations, and grade III–IV dyspnea. In the chaotic environment of a busy ED, the most probable diagnosis here will be ACS. Comorbid conditions like diabetes mellitus, hypertension, and prior coronary artery disease (CAD) are commonly enquired. However, other long-standing illnesses like myasthenia gravis (MG), as in our patient can be easily missed if a patient is not forthcoming with history. We experienced a similar confusion when in the cacophony of chest pain, dyspnea, and T wave inversions with bundle branch blocks, ACS protocol was initiated and a simple diagnosis was missed. The significance of the alternating bundle branch block (ABBB) will be presented to the readers. How to cite this article Hymavathi A, Uppaluri SC, Sharma A. Alternating Bundle Branch Block or Pyridostigmine-induced Mobitz Type II Block Masquerading as Acute Coronary Syndrome. J Med Acad 2020;3(2):63–66.

scholarly journals ST Segment Elevation in aVR: Clinical Significance in Acute Coronary Syndrome

2013 ◽  
Vol 6 ◽  
pp. CCRep.S11261 ◽  
Author(s):  
Antoine Kossaify
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Medical Data ◽  
Current Medical ◽  
Coronary Angiogram ◽  
Bundle Branch Block ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Previous Medical History

A 59-year-old-male patient with no previous medical history presented with oppressive chest pain; initial electrocardiogram showed ST segment elevation in aVR and V1, with intermittent right bundle branch block. Emergent coronary angiogram showed a proximal sub-occlusive stenosis of the left anterior descending artery, and the patient was hemodynamically unstable during the first 72 hours. Insights into the significance of ST segment elevation in aVR are presented and discussed in light of the current medical data.

scholarly journals PERAN PERAWAT DALAM IDENTIFIKASI DINI DAN PENATALAKSANAAN PADA ACUTE CORONARY SYNDROME

2018 ◽  
Vol 8 (2) ◽  
Author(s):  
Nur Ainiyah
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Nursing Care ◽  
Early Identification ◽  
Literature Search ◽  
Ecg Changes ◽  
Knowledge And Skills ◽  
Coronary Syndrome

The role of nurses in the early identification and treatment on Acute Coronary Syndrome. Introduction : Acute Coronary Syndrome ( ACS ) is an emergency in the coronary arteries . Nurses are very necessary to provide treatment of acute coronary syndrome accurately and precisely both prehospital and intrahospital . Methods: The literature search from April 2006 through April 2016 in MEDLINE, NCBI, CINAHL using key words : Acute Coronary Syndrome, treatment and does not restrict the research sampling. Results: Based on the literature review 10 obtained the enforcement of early diagnosis of ACS should be done immediately, which can be done by looking of three criteria: chest pain, ECG changes and sign biochemical (biomarker serum). Discussion: The nursing care must have role in the management of ACS. Therefore the quality of care given depends on the knowledge and skills of nurses both prehospital and intrahospital

scholarly journals Occult pneumomediastinum in a SARS patient presenting as recurrent chest pain and acute ECG changes mimicking acute coronary syndrome

Respirology ◽  
2004 ◽  
Vol 9 (2) ◽  
pp. 271-273 ◽  
Author(s):  
Tak-Sun TSE ◽  
Kin-Lam TSUI ◽  
Loretta Y-C. YAM ◽  
Loletta K-Y. SO ◽  
Arthur C-W. LAU ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Ecg Changes ◽  
Coronary Syndrome

scholarly journals Efficacy of thrombolytics in patients with acute coronary syndrome

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
A Vasin ◽  
O Mironova ◽  
V Fomin
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Thrombolytic Therapy ◽  
Prehospital Care ◽  
Optimal Choice ◽  
Hospital Treatment ◽  
Complication Rates ◽  
Coronary Syndrome ◽  
Thrombolytic Drug ◽  
Systemic Thrombolytic Therapy

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction: The optimal choice of the thrombolytic drug for emergency revascularization in patients with acute coronary syndrome (ACS) still remains to be defined. Percutaneous coronary intervention is a more safe and effective method of reperfusion compared with thrombolytic therapy, that’s why the last is relatively not common nowadays. But in the COVID-19 era in a number of cases some patients with ACS can’t be quickly hospitalized due to different reasons like the absence of the nearest available cardiovascular center, or lack of an ambulance. A long period of chest pain forces the doctors to use systemic thrombolytic therapy. Purpose This study investigates the efficacy and safety of Alteplase, Prourokinase, Tenecteplase, and Streptokinase in patients with acute coronary syndrome. Methods A retrospective, open, non-randomized cohort study was conducted. We have analysed 600 patients with ACS, who underwent systemic thrombolytic therapy at the prehospital and in-hospital stages from 2009 to 2011. Patients were divided into several groups according to the thrombolytic agent administered: Alteplase (254 patients), Prourokinase (309 patients), Tenecteplase (6 patients), Streptokinase (31 patients). Treatments were to be given as soon as possible. The ECG reperfusion criterion was a decrease in the ST segment by 50% or more from the initial elevation. Results  Among 600 patients (mean age, 61 years (SD = 20); 119 women [19.7%]), 440 had successful reperfusion. The median time from chest pain onset to the start of treatment was 3 hours (P < 0.001). The percentages of successful thrombolysis for each agent were similar: Alteplase 74,4% Prourokinase 71,2%, Tenecteplase 83%, Streptokinase 74,2%. No statistical differences were observed in thrombolytic results among these groups (OR: 0.60, 95% CI: 0,2868 to 1,217; P = 0.17). At the same time, the hospital treatment with prourokinase was more effective than prehospital care with prourokinase: 110 successful reperfusions in 138 patients (79.7%) and 110 successful reperfusions in 171 patients (64.3%), respectively. Regardless of the onset of the attack (OR: 0.45, 95% CI: 0,2004 to 0,9913; P = 0.05). The effectiveness of the other thrombolytics cannot be compared between prehospital care and hospital treatment due to the rare use at the hospital stage in our cases. In the study, there was also no statistical difference in complication rates among the treatment groups. Among all patients, there were 9 fatal outcomes (1.5%): Alteplase 3,15% Prourokinase 1,9%, Streptokinase 3,22%. Conclusion(s): In patients with ACS, all thrombolytic drugs showed similar effectiveness. There is no difference in the safety and efficacy among the agents in our study, but there is a difference in cost and route of administration. However, upcoming prospective trials with long follow-up periods might be expected to determine the most appropriate systemic thrombolytic drug.

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