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.

scholarly journals Diagnostic markers for discriminating between acute aortic dissection and acute myocardial infarction during the pre-hospital phase: analysis of 3,195 cases

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Watanabe ◽  
H Yoshino ◽  
T Takahashi ◽  
M Usui ◽  
K Akutsu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Back Pain ◽  
Chest Pain ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Diagnostic Markers ◽  
Network Database ◽  
History Of ◽  
First Contact

Abstract   Both acute aortic dissection (AAD) and acute myocardial infarction (AMI) present with chest pain and are life-threatening diseases that require early diagnosis and treatment for better clinical outcome. However, two critical diseases in the very acute phase are sometimes difficult to differentiate, especially prior to arrival at the hospital for urgent diagnosis and selection of specific treatment. The aim of our study was to clarify the diagnostic markers acquired from the information gathered from medical history taking and physical examination for discriminating AAD from AMI by using data from the Tokyo Cardiovascular Care Unit (CCU) Network database. We examined the clinical features and laboratory data of patients with AAD and AMI who were admitted to the hospital in Tokyo between January 2013 and December 2015 by using the Tokyo CCU Network database. The Tokyo CCU Network consists of >60 hospitals that fulfil certain clinical criteria and receive patients from ambulance units coordinated by the Tokyo Fire Department. Of 15,061 patients diagnosed as having AAD and AMI, 3,195 with chest pain within 2 hours after symptom onset (537 AAD and 2,658 AMI) were examined. The patients with out-of-hospital cardiac arrest were excluded. We compared the clinical data of the patients with chest pain who were diagnosed as having AAD and AMI. The following indicators were more frequent or had higher values among those with AAD: female sex (38% vs. 20%, P<0.001), systolic blood pressures (SBPs) at the time of first contact by the emergency crew (142 mmHg vs. 127 mmHg), back pain in addition to chest pain (54% vs. 5%, P<0.001), history of hypertension (73% vs. 58%, P<0.001), SBP ≥150 mmHg (39% vs. 22%, P<0.001), back pain combined with SBP ≥150 mmHg (23% vs. 0.8%, P<0.001), and back pain with SBP <90 mmHg (4.5% vs. 0.1%, P<0.001). The following data were less frequently observed among those with AAD: diabetes mellitus (7% vs. 28%, P<0.001), dyslipidaemia (17% vs. 42%, P<0.001), and history of smoking (48% vs. 61%, P<0.001). The multivariate regression analysis suggested that back pain with SBP ≥150 mmHg (odds ratio [OR] 47; 95% confidence interval [CI] 28–77; P<0.001), back pain with SBP <90 mmHg (OR 68, 95% CI 16–297, P<0.001), and history of smoking (OR 0.49, 95% CI 0.38–0.63, P<0.001) were the independent markers of AAD. The sensitivity and specificity of back pain with SBPs of ≥150 mmHg and back pain with SBPs <90 mmHg for detecting AAD were 23% and 99%, and 4% and 99%, respectively. In patients with chest pain suspicious of AAD and AMI, “back pain accompanied by chest pain with SBP ≥150 mmHg” or “back pain accompanied by chest pain with SBP <90 mmH” is a reliable diagnostic marker of AAD with high specificity, although the sensitivity was low. The two SBP values with back pain are markers that may be useful for the ambulance crew at their first contact with patients with chest pain. Funding Acknowledgement Type of funding source: None

Acute myocardial infarction and chest pain syndromes after cocaine use

1990 ◽  
Vol 66 (20) ◽  
pp. 1434-1437 ◽  
Author(s):  
Mahesh Amin ◽  
Gary Gabelman ◽  
Jill Karpel ◽  
Peter Buttrick
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Cocaine Use ◽  
Pain Syndromes

scholarly journals Nearly Asymptomatic Eight-Month Thoracic Aortic Dissection

2016 ◽  
Vol 10 ◽  
pp. CMC.S38328 ◽  
Author(s):  
Arjun Kumar ◽  
Krishan Kumar ◽  
Roman Zeltser ◽  
Amgad N. Makaryus
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Aortic Dissection ◽  
Medical Condition ◽  
Unique Case ◽  
Thoracic Aortic Dissection ◽  
Aortic Dissections

Thoracic aortic dissection is a rare, but lethal, medical condition that is either misdiagnosed as a myocardial infarction or overlooked completely. Though thoracic aortic dissections are commonly diagnosed in patients exhibiting sharp chest pain, there are some notable cases where patients do not report the expected severity of pain. We report a unique case of a patient with a thoracic aortic dissection who was initially nearly asymptomatic for eight months, in order to heighten awareness, highlight diagnosis protocol, and improve prognosis for this commonly misdiagnosed, but fatal, condition.

scholarly journals Mimic high lateral myocardial infarction in chest tetany with mirror electrocardiographic change, Movable phenomenon (Yasser’s phenomenon), and coronary spasm; dramatic Oxygen reversal

2021 ◽  
Vol 3 (3) ◽  
pp. 01-05
Author(s):  
Yasser Mohammed Hassanain Elsayed
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Artery Spasm ◽  
Coronary Spasm ◽  
Electrocardiographic Change ◽  
St Segment ◽  
Patient Concerns ◽  
Calcium Injection

Rationale: Tetany is a common, serious, well-established endocrinal and metabolic hypocalcemic disorder. Chest tetany is a novel metabolic term in hypocalcemia characterized by acute severe twisting chest pain. Movable phenomenon (Yasser’s phenomenon) is a new phenomenon that is usually associated with hypocalcemia. oxygenation may have a role in the management of coronary artery spasm. Patient concerns: A middle-aged farmer smoker male patient presented to physician outpatient clinic with tetany, mimic high lateral myocardial infarction, mirror electrocardiographic change, Movable phenomenon (Yasser’s phenomenon), and coronary artery spasm. Diagnosis: Mimic high lateral myocardial infarction in chest tetany with mirror electrocardiographic change, Movable phenomenon (Yasser’s phenomenon), and coronary artery spasm. Interventions: Electrocardiography, oxygenation, IV calcium injection, and echocardiography. Outcomes: Acute dramatic clinical and electrocardiographic improvement had happened. Lessons: The reversal of mirror electrocardiographic change, reversal of ST-segment depression coronary artery spasm, and normalization of Movable phenomenon (Yasser’s phenomenon) after oxygenation. It signifies the role of oxygen in both coronary artery spasm and tetany. Mirror local electrocardiographic change is a novel described expression that may reflect the myocardial polarity in this chest tetany.

scholarly journals SAT-462 Coronary Vasospasm-Induced Myocardial Infarction: An Uncommon Presentation of Thyrotoxicosis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Basma Ataallah ◽  
Barjinder Buttar ◽  
Georgia Kulina ◽  
Alan Kaell
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Coronary Artery Spasm ◽  
Coronary Spasm ◽  
Coronary Vasospasm ◽  
Graves Disease ◽  
Normal Coronary Arteries ◽  
Coronary Artery Vasospasm

Abstract Background: Coronary artery vasospasm-induced myocardial infarction is a rare cardiac complication of untreated thyrotoxicosis. Diagnosis is difficult due to the transient and unpredictable occurrence of coronary spasm [1]. Clinical Case: A 47-year-old Hispanic female smoker presented with a one-week history of severe, intermittent substernal chest pain radiating to the left arm. The pain was associated with palpitations and shortness of breath. She was afebrile with a heart rate of 100, a blood pressure of 119/59, a fine tremor, and brisk reflexes. No lid lag or proptosis was appreciated. The thyroid was enlarged, non-tender, without palpable nodules. ECG showed T- Wave Inversions in leads V1-V2 and ST depressions in V4-V5. Chest pain was relieved by SL nitroglycerin. Lab results showed a peak Troponin of 0.20 (N < 0.06), TSH 0.01 mU/L (N > 0.45mU/L), free T4 5.54 (N < 1.46 ng/dl), total T3 4.50 pg/mL (N < 1.37 ng/mL), free T3 21.0 ng/mL (N < 4.4 pg/ml), TSI 3.61 IU/L (N < 0.55 IU/L), thyrotropin R Ab 7.47 IU/L (N < 1.75 IU/L) and thyroglobulin Ab 1.3 IU/ml (ULN < 0.9 IU/ml). Thyroid US showed a heterogeneous enlarged thyroid gland with increased vascularity. For her NSTEMI she was treated with a heparin drip, aspirin, clopidogrel, atorvastatin, propranolol, and isosorbide mononitrate. Methimazole was started to treat thyrotoxicosis. Cardiac catheterization revealed coronary vasospasm without evidence of valvular or coronary artery disease. Methimazole restored euthyroidism and she has not had recurrence of angina. Discussion: Rarely, hyperthyroidism can present with transient myocardial ischemia secondary to coronary artery vasospasm in patients with normal coronary arteries. The etiopathogenesis is unclear and may relate to a direct metabolic effect of excess thyroid hormone on the myocardium. In a Korean study evaluating chest pain in patients who underwent coronary angiography, the incidence of coronary vasospasm was 5%, occurring most frequently in women under 50 years of age with thyrotoxicosis [2]. Conclusion: Patients who present with angina and are thyrotoxic should be evaluated for vasospasm. Females under 50 years old with Graves’ disease are at highest risk. Treatment includes antithyroid medications along with nitroglycerin, and we can consider calcium channel blockers including diltiazem. Treatment of thyrotoxicosis eliminates recurrence of vasospasm [3]. References 1. Chudleigh RA, Davies JS: Grave’s thyrotoxicosis and coronary artery spasm. Postgrad Med J. 2007, 83(985):e1-e2. 2. Zheng W, Zhang YJ, Li SY, et al: Painless thyroiditis-induced acute myocardial infarction with normal coronary arteries. Am J Emerg Med. 2015, 33:5-10. 3. Marah N, Bryant K, Haq S, Khan M: Graves’ disease-induced coronary vasospasm. JACC: Cardiovascular Interventions. 2016, 9(23):2452-2453.

scholarly journals Slowly Progressive and Painless Thoracic Aortic Dissection Presenting with a Persistent Fever in an Elderly Patient: The Usefulness of Combined Measurement of Biochemical Parameters

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Shunsuke Yamada ◽  
Masanori Tokumoto ◽  
Toshiaki Ohkuma ◽  
Yasuo Kansui ◽  
Yoshinobu Wakisaka ◽  
...  
Keyword(s):  
Chest Pain ◽  
Aortic Dissection ◽  
Medical Condition ◽  
Correct Diagnosis ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Unknown Origin ◽  
Sudden Onset ◽  
Proper Diagnosis ◽  
Typical Chest Pain

Aortic dissection is a fatal medical condition that requires urgent diagnosis and appropriate intervention. Because acute aortic dissection often manifests as sudden onset excruciating chest pain, physicians can easily reach a proper diagnosis. However, some patients with aortic dissection present with varied clinical manifestations without exhibiting typical chest pain, leading to a delayed diagnosis and possible fatality. We herein present the case of an elderly subject with a fever of unknown origin who was ultimately diagnosed with aortic dissection. In the present case, a negative procalcitonin test, increased D-dimer and serum creatinine phosphokinase-BB levels, and reelevation of the CPR level led us to the correct diagnosis.

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 Myocarditis mimicking acute aortic dissection

2019 ◽  
Vol 12 (7) ◽  
pp. e230592
Author(s):  
Matthew Hammond-Haley ◽  
Christopher Allen ◽  
Tiffany Patterson ◽  
Simon R Redwood
Keyword(s):  
Myocardial Infarction ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Acute Myocarditis ◽  
Invasive Coronary Angiography ◽  
Sudden Onset ◽  
Chest Discomfort ◽  
St Segment Elevation ◽  
St Segment ◽  
Severe Back Pain

We report a case of myocarditis that closely mimicked acute aortic dissection in a young woman. The initial presentation was with sudden onset severe back pain and chest discomfort, associated with bilateral arm paraesthesia. The initial ECG demonstrated inferior ST-segment elevation with reciprocal anterior changes. The diagnosis was facilitated by urgent echocardiography, a CT aortogram and invasive coronary angiography to exclude aortic dissection and myocardial infarction, respectively. Acute myocarditis was later confirmed on cardiac MRI. The patient was treated conservatively with no subsequent arrhythmias with preservation of biventricular function.

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