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.

scholarly journals Ventricular Fibrillation Cardiac Arrest in Young Female from Diffuse Left Anterior Descending Coronary Vasospasm

2019 ◽  
Vol 3 (4) ◽  
pp. 395-397
Author(s):  
Christopher Wilson ◽  
Eric Melnychuk ◽  
John Bernett
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Cardiac Arrest ◽  
Chest Pain ◽  
Coronary Artery ◽  
Ventricular Fibrillation ◽  
Young Female ◽  
Coronary Vasospasm ◽  
Fatal Complication ◽  
St Elevation

This is a case of the most severe and potentially fatal complication of coronary artery vasospasm. We report a case of a 40-year-old female presenting to the emergency department (ED) via emergency medical services with chest pain. The patient experienced a ventricular fibrillation cardiac arrest while in the ED. Post-defibrillation electrocardiogram showed changes suggestive of an ST-elevation myocardial infarction (STEMI). Cardiac catheterization showed severe left anterior descending spasm with no evidence of disease. Coronary vasospasm is a consideration in the differential causes of ventricular fibrillation and STEMI seen in the ED.

scholarly journals Identification of high-risk non-ST elevation myocardial infarction at presentation to emergency department. A prospective observational cohort study in North West England

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e030128
Author(s):  
Aleem Khand ◽  
Freddy Frost ◽  
Ruth Grainger ◽  
Michael Fisher ◽  
Pei Chew ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Chest Pain ◽  
High Risk ◽  
Troponin T ◽  
Invasive Coronary Angiography ◽  
Multivariate Logistic Regression Analysis ◽  
St Elevation Myocardial Infarction ◽  
Heart Score ◽  
St Elevation

ObjectivesEarly access to invasive coronary angiography and revascularisation for high-risk non-ST elevation myocardial infarction (NSTEMI) improves outcomes and is supported by current guidelines. We sought to determine the most effective criteria at presentation to emergency department (ED) to identify high-risk NSTEMI.SettingSecondary care centre northwest England with national follow-up.Participants1642 consecutive patients (median age 59, 52% male) presenting to ED with a primary symptom of chest pain in whom there is suspicion of NSTEMI.Primary and secondary measuresMultivariate logistic regression analysis for the prediction of all-cause death (primary) and major adverse cardiac event (MACE defined as all-cause death, unplanned coronary revascularisation and adjudicated NSTEMI (third universal definition)) (secondary measure) at 1 year.ResultsThe incidence of adjudicated NSTEMI was 10.7%, and 1-year mortality was 6.3%. Independent predictors for all-cause death at 1 year were Global Registry of Acute Coronary Events (GRACE) >140, age (per decade increase) and high-sensitive cardiac troponin T (hs-cTnT) >50 ng/L. hs-cTnT >50 ng/L was associated with adjudicated index presentation NSTEMI in the greatest proportion of patients (61.7%). When using MACE at 12 months, as opposed to all-cause death, as an end point History, ECG, Age, Risk factors and Troponin (HEART) score ≥7 was included in the multivariate model and had better prediction of index NSTEMI than GRACE>140. Combining hs-cTnT >50 ng/L and a second independent predictor identified both a high proportion of index NSTEMI and elevated risk of all-cause death at 1 year.Conclusionshs-cTnT >50 ng/L or HEART score ≥7 appear effective strategies to identify high-risk NSTEMI at presentation to emergency room with chest pain. Multicentre prospective studies enriched with early presenters, and with competitor high-sensitive and point-of-care troponins, are required to validate and extend these findings.Trial registration numberNCT02581540.

scholarly journals A mimic of a STEMI in an elderly male patient at emergency department requiring no stent

2021 ◽  
Vol 2 (5) ◽  
Author(s):  
Lagath Wanigabadu ◽  
◽  
Jithesh Choyi ◽  
Shahram Ahmadvazi ◽  
Sarah Justice ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Coronary Angiography ◽  
Male Patient ◽  
Apical Ballooning ◽  
Elderly Male ◽  
Coronary Syndrome ◽  
St Elevation

An elderly male patient presented with chest pain and an initially abnormal ECG, with 1 mm ST elevation in the lateral leads. As he was pain free on arrival, he was treated locally, where a coronary angiography showed no stenosis and echocardiography showed apical ballooning which indicated Takotsubo Cardiomyopathy (TC). On further questioning, he indicated he has been worrying about his son’s financial circumstances. Patients with TC can present with a history and an ECG resembling and indistinguishable from ST-elevation Myocardial infarction or other types of Acute Coronary Syndrome (ACS).

scholarly journals Cocaine-induced myocardial injury

2019 ◽  
Vol 25 (1) ◽  
pp. 40-43
Author(s):  
Jolita Badarienė ◽  
Lina Matuliauskaitė ◽  
Robertas Badaras ◽  
Birutė Petrauskienė
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Chest Pain ◽  
Myocardial Injury ◽  
Young Patients ◽  
Acute Chest Pain ◽  
University Hospital ◽  
Cocaine Use ◽  
St Elevation ◽  
Vilnius University

Summary We report a case of 37-year-old male, who was admitted to the Vilnius University hospital Santaros Klinikos emergency department suffering from acute chest pain. ECG and elevated troponin level confirmed ST-elevation myocardial infarction, although coronary angiogram had not shown hemodynamically significant changes in coronary arteries. Patient admitted after using cocaine a day ago. To conclude, myocardial infarction is rare, but serious consequence of cocaine use. Clinicians should consider interrogating all young patients presented to the emergency department with acute chest pain for cocaine use.

scholarly journals Thyroid Storm-induced Takotsubo Cardiomyopathy Presenting as Acute Chest Pain: A Case Report

2021 ◽  
Vol 5 (4) ◽  
pp. 399-402
Author(s):  
Brayden Ashdown ◽  
Emilie Hynes
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Case Report ◽  
Chest Pain ◽  
Hospital Mortality ◽  
Acute Chest Pain ◽  
Thyroid Storm ◽  
Emergency Physicians ◽  
Healthy Female ◽  
St Elevation

Introduction: Stress-induced cardiomyopathy is a rare but serious cause of chest pain, which in recent studies has been shown to carry a similar in-hospital mortality to acute ST-elevation myocardial infarction. The pathophysiology of the disease is thought to be secondary to dysregulated catecholamine effects on myocardium. Case Report: We present a case of a previously healthy female without known thyroid disease who presented to the emergency department for acute chest pain and was found to have thyroid storm-induced cardiomyopathy in a typical stress-induced cardiomyopathy pattern without evidence of coronary disease on catheterization. Conclusion: Thyrotoxicosis can cause dysregulation of catecholamines and is a rare cause of stress-induced cardiomyopathy. It requires distinct therapies and should be considered by emergency physicians in the workup of acute chest pain with concern for stress-induced cardiomyopathy.

scholarly journals Cardiogenic shock and radial access in patients with an acute ST elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Zahn ◽  
M Hochadel ◽  
B Schumacher ◽  
M Pauschinger ◽  
C Stellbrink ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
St Elevation Myocardial Infarction ◽  
Strong Variation ◽  
Access Site ◽  
Femoral Access ◽  
Radial Access ◽  
St Elevation ◽  
The Difference

Abstract Background Cardiogenic shock (CS) in patients (pts) with acute ST elevation myocardial infarction (STEMI) is the strongest predictor of hospital mortality. Radial in contrast to femoral access in STEMI pts might be associated with a lower mortality. However, little is known on radial access in CS pts. Methods We retrospectively analysed all STEMI pts between 2009 and 2015 who sufferend from CS and who were included into the ALKK PCI registry. Pts treated via a radial access were compared to those treated via a femoral access. Results Between 2009 and 2015 23796 STEMI pts were included in the registry. 1763 (7.4%) of pts were in CS. The proportion of radial access was 6.6%: in 2009 4.0% and in 2015 19.6%, p for trend <0.0001 with a strong variation between the participating centres (0% to 37%). Conclusions Radial access was only used in 6.6% of STEMI pts presenting in CS. However, a significant increase in the use of radial access was observed over time (2009: 4%, 2015 19.6%, p<0.001), with a great variance in its use between the participating hospitals. Despite similar pt characteristics the difference in hospital mortality according to access site has to be interpretated with caution. Funding Acknowledgement Type of funding source: None

scholarly journals Cerebral embolism due to left atrial myxoma in a patient presenting with chest pain and ST-segment elevation: a case report

2020 ◽  
Author(s):  
António Fontes ◽  
Nuno Dias-Ferreira ◽  
Anabela Tavares ◽  
Fátima Neves
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Magnetic Resonance ◽  
Left Atrial ◽  
Left Ventricular ◽  
Atrial Myxoma ◽  
Left Atrial Myxoma ◽  
St Segment ◽  
Wide Range ◽  
St Elevation

Abstract Background Myocarditis is an uncommon, potentially life-threatening disease that presents with a wide range of symptoms. In acute myocarditis, chest pain (CP) may mimic typical angina and also be associated with electrocardiographic changes, including an elevation of the ST-segment. A large percentage (20–56%) of myxomas are found incidentally. Case summary A 62-year-old female presenting with sudden onset CP and infero-lateral ST-elevation in the electrocardiogram. The diagnosis of ST-elevation myocardial infarction was presumed and administered tenecteplase. The patient was immediately transported to a percutaneous coronary intervention centre. She complained of intermittent diplopia during transport and referred constitutional symptoms for the past 2 weeks. Coronary angiography showed normal arteries. The echocardiogram revealed moderate to severe left ventricular systolic dysfunction due to large areas of akinesia sparing most of the basal segments, and a mobile mass inside the left atrium attached to the septum. The cardiac magnetic resonance (CMR) suggested the diagnosis of myocarditis with concomitant left atrial myxoma. The patient underwent resection of the myxoma. Neurological evaluation was performed due to mild vertigo while walking and diplopia in extreme eye movements. The head magnetic resonance imaging identified multiple infracentimetric lesions throughout the cerebral parenchyma compatible with an embolization process caused by fragments of the tumour. Discussion Myocarditis can have various presentations may mimic acute myocardial infarction and CMR is critical to establish the diagnosis. Myxoma with embolic complications requires emergent surgery. To the best of our knowledge, this is the first case reported in the applicable literature of a myxoma diagnosed during a myocarditis episode.

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