A Rare Cardiac Neoplasm Presenting as a Chest Pain

2012 ◽  
Vol 8 (3) ◽  
pp. 223
Author(s):  
Hemasri Tokala ◽  
Jagadeesh Kalavakunta ◽  
Heather Laird-Fick ◽  
Sreenivas Kamath ◽  
Vishal Gupta ◽  
...  
Keyword(s):  
Chest Pain ◽  
Sudden Onset ◽  
Adrenergic Blockade ◽  
Computed Tomography Scan ◽  
Acute Pericarditis ◽  
Cardiac Neoplasm ◽  
Cardiac Tumours ◽  
St Elevation ◽  
Jugular Venous Distension ◽  
Tomography Scan

Cardiac paragangliomas are the rarest primary cardiac tumours and account for less than one percent of cases. A 24-year-old man presented with complaints of sudden onset of chest pain. The pain started suddenly when he was skiing halfway down the slope and went into a tuck position. Physical examination was significant for elevated jugular venous distension. His electrocardiogram revealed diffuse ST elevation suggestive of acute pericarditis. The echocardiogram revealed pericardial effusion with tamponade physiology. He underwent emergent pericardiocentesis, but the effusion rapidly re-accumulated, requiring a second pericardiocentesis. Computed tomography scan of the chest revealed haemorrhage in the anterior left mediastinum with pericardial extension. The patient underwent emergency cardiac surgery. A 5.0 x 4.5 x 3.2 cm mass, diagnosed histopathologically as paraganglioma, was excised without complication. In all cardiac or extra cardiac tumours we should check pre-operatively for hormonal activity and pre-operative and intra-operative adrenergic blockade must be employed in all secretory paragangliomas.

scholarly journals A rare interesting case of fatal air embolism after intravenous contrast during computed tomography

2021 ◽  
Vol 17 (4) ◽  
pp. 93-96
Author(s):  
Naved Y. Hasan ◽  
Asiah Salem Rugaan
Keyword(s):  
Computed Tomography ◽  
Fatal Case ◽  
Pulseless Electrical Activity ◽  
Air Embolism ◽  
Sudden Onset ◽  
Radiology Department ◽  
Computed Tomography Scan ◽  
Intravenous Contrast ◽  
Shock State ◽  
Tomography Scan

We are reporting a fatal case of air embolism. Although minor cases of air embolism may go unnoticed, this is a case of fatal air embolism after intravenous entry of air, which presented with sudden onset of pulseless electrical activity during a computed tomography scan in the radiology department, requiring cardiopulmonary resuscitation for 15 min. Subsequently, after admission to the intensive care unit, we achieved return of spontaneous circulation. The patient was intubated and ventilated in a shock state. He remained in refractory shock despite of supportive care. Cardiaс arrest was registered again in the catheterization lab and the patient could not be revived after 4 h from the initial cardiac arrest. А computed tomography scan was reported to reveal a significant amount of intra-cardiac air, which was the likely cause patient’s death. The case is a rare condition, which highlights the importance of early diagnosis and delivers a message to the medical staff to have a high index of suspicion in patients who have risk factors, and who develop sudden shock with hypoxemia, in order to treat this potentially life-threatening condition effectively in a timely manner.

scholarly journals Noncompaction and Takotsubo Syndrome in a Neuromuscular Disorder

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Josef Finsterer ◽  
Claudia Stöllberger ◽  
Walter Benedikt Winkler
Keyword(s):  
Chest Pain ◽  
Beta Blockers ◽  
Liver Cyst ◽  
Neuromuscular Disorder ◽  
Sudden Onset ◽  
Left Ventricular ◽  
Takotsubo Syndrome ◽  
Troponin Elevation ◽  
History Of ◽  
St Elevation

Background. Takotsubo syndrome (TTS) in patients with left ventricular hypertrabeculation/noncompaction (LVHT) has been reported in four patients, and a TTS plus LVHT plus a neuromuscular disorder (NMD) was only reported once so far. Here, we present the fifth patient with LVHT and TTS and the second patient with LVHT, TTS, and a NMD. Methods and Results. The patient is a 68 yo female hobby choir singer with a history of skin dermatofibroma, skin fibrokeratoma, arterial hypertension, hyperlipidemia, hypothyroidism, anemia, hyponatremia, diverticulosis, LVHT detected at age 60 y, five syncopes, a liver cyst, and carotid endarterectomy 2 months prior to admission because of sudden-onset chest pain. Workup revealed ST elevation, troponin elevation, and mild coronary artery sclerosis. Ventriculography and transthoracic echocardiography (TTE) showed the apical type of a TTS. ECG normalised within 10 w and TTE within 6 w under beta-blockers and ATII-blockers. The TTS was triggered by being offended of being unable to sing anymore after endarterectomy. Neurological workup suggested the presence of a NMD. Conclusions. This case shows that LVHT occurs in NMD patients and that patients with LVHT and a NMD may develop a TTS. Whether patients with LVHT and a NMD are particularly prone to develop a TTS requires further confirmation. NMD patients with LVHT should avoid stress not to trigger a TTS.

scholarly journals False-Positive Elevation of CK-MB Levels with Chest Pain in Lung Adenocarcinoma

2020 ◽  
Vol 13 (1) ◽  
pp. 100-104
Author(s):  
Takayo Ota ◽  
Yoshikazu Hasegawa ◽  
Eriko Murata ◽  
Noriko Tanaka ◽  
Masahiro Fukuoka
Keyword(s):  
Chest Pain ◽  
Lung Adenocarcinoma ◽  
Cardiac Injury ◽  
Electrophoretic Analysis ◽  
Computed Tomography Scan ◽  
Laboratory Findings ◽  
Coronary Syndrome ◽  
Visceral Pleural Invasion ◽  
Tomography Scan

The creatinine kinase (CK)-MB assay can be used for the early diagnosis of acute coronary syndrome. We describe the case of an 82-year-old male with lung adenocarcinoma who presented with chest pain. While laboratory findings showed elevated CK-MB levels, there was no cardiac injury. A chest computed tomography scan revealed pleural carcinomatosis. Later, electrophoretic analysis of CK showed a normal CK-MB range but increased CK-BB levels and the presence of macro CK type 2. We determined that the patient’s chest pain originated from the visceral pleural invasion of lung cancer. Because of the methods used to measure the CK-MB isozyme, the CK-MB level appeared elevated.

scholarly journals Dissection aortique lors de la délivrance par césarienne

2019 ◽  
Vol 6 (1) ◽  
pp. 51-53
Author(s):  
Baya AZIZA ◽  
◽  
Samiha CHERIF ◽  
Bouzid ABDELMALEK
Keyword(s):  
Chest Pain ◽  
Aortic Dissection ◽  
Young Women ◽  
Gestational Hypertension ◽  
Acute Chest Pain ◽  
Successful Outcome ◽  
Computed Tomography Scan ◽  
Chest Computed Tomography ◽  
Pregnancy Hypertension ◽  
Tomography Scan

Aortic dissection is unusual in young women, but when it occurs it is frequently associated with pregnancy and more importantly with pregnancy hypertension. A 37 old women with gestational hypertension was presented with chest pain during delivery by cesarean section and chest computed tomography scan was done and showed an aortic dissection; she was operated in an emergency with a successful outcome after delivery. Our aim is to put the point on the need to suspect the diagnosis of aortic dissection in a patient with preeclampsia and who complains of acute chest pain.

Abstract 14064: Left Circumflex Lesion a Great Masquerader: Stemi Mimicking Classic Pericarditis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Roshan Jha ◽  
Qiu Tong ◽  
Cameron Hall
Keyword(s):  
Chest Pain ◽  
Acute Chest Pain ◽  
Posterior Wall ◽  
Abrupt Onset ◽  
Circumflex Artery ◽  
Acute Pericarditis ◽  
Tobacco Abuse ◽  
St Elevation ◽  
Low Threshold ◽  
Atypical Presentations

Introduction: Pericarditis and STEMI both present with acute chest pain and ST elevations in the EKG. The pattern of ST-elevation and the nature of chest pain usually aid in clinching the diagnosis but there are exceptions. Case: 34 Y.o male with Hypertension, tobacco abuse presented with abrupt onset central chest tightness, worsening with inspiration, relieved on sitting up. EKG revealed diffuse concave ST elevation in all leads with PR depression, Posterior EKG was negative for posterior wall MI. Troponin was normal on presentation and was mildly elevated to 0.5 ng/ml 6 hours later. The echocardiogram revealed normal ejection fraction, no wall motion changes. He was being managed for acute pericarditis with colchicine and ibuprofen, 20 hours later, he experienced increased chest pain, repeat EKG was unchanged, troponin up-trended to 6 ng/ml, peaked at 20 ng/ml and was taken for an urgent angiogram. Angiogram revealed an occlusion in the mid circumflex artery and angioplasty was done. Following the procedure, the chest pain subsided. Conclusion: A classic presentation of acute pericarditis turned out to be a STEMI with circumflex as the culprit vessel. Vigilance to patient's symptoms and trending of cardiac markers are essential in identifying atypical presentations of STEMI. The circumflex lesion usually has an atypical presentation and should have a low threshold for diagnostic angiogram so as not to miss them.

scholarly journals Spontaneous coronary artery dissection

2013 ◽  
Vol 9 (1) ◽  
pp. 59-62
Author(s):  
Ranjit Sharma ◽  
Rajeeb Rajbhandari ◽  
Yubraj Limbu ◽  
Satish Singh ◽  
YKD Bhatt ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chest Pain ◽  
Healthy Woman ◽  
Lateral Wall ◽  
Sudden Onset ◽  
Cardiac Biomarkers ◽  
Artery Dissection ◽  
Coronary Artery Dissection ◽  
History Of ◽  
St Elevation

A 38 year old previously healthy woman was referred to ER for ongoing chest pain. She had sudden onset of central, crushing chest pain 3 h back and her ECG was found to have evidence of acute infero-lateral wall MI. There was no history of cardiovascular disease or identifiable CAD risk factors. She had a history of bone TB 10 y back. She was on oral contraceptive pills 5 y back. Her mother had hypertension and diabetes mellitus. Her father died at the age of 75 y due to unknown cause and had a history of hypertension. There is no history of hypertension, diabetes mellitus or CVD in her siblings. General Examination: O2 saturation-95%, Pulse-88bpm, Bp-110/90mmHg.Systemic Examination: no abnormality detected. Investigation: CBC, RFT, BSR, and Electrolytes were WNL. ECG: ST elevation in infero-lateral leads 3 h back but minimal ST elevation in lll and AVF in our ER. Cardiac Biomarkers: CPK-MB-50u/l and Trop + .Echo screening: hypokinetic apex, apical IVS and apical inferior LV wall. She was diagnosed as acute infero-lateral wall MI and was admitted in CCU was treated with Aspirin, Clopidogrel ,LMWH ,Atorvastatin ,IV GTN , Beta-Blocker, Anxiolytics ,PPI and Stool softener .She was well on first post MI day but suddenly developed chest pain on second post MI day and her ECG showed ST elevation in V3-V6. She was taken to Cath lab for rescue PCI. Her coronary angiography studies revealed a linear dissection involving the distal LAD with TIMI 3 distal flow (Fig1). She was conservatively management and was discharged on 7 post MI day. DOI: http://dx.doi.org/10.3126/njh.v9i1.8352 Nepalese Heart Journal Vol.9(1) 2012 pp.59-62

scholarly journals Emergency medical services evaluations for chest pain during first COVID-19 lockdown in Hollands-Midden, the Netherlands

2021 ◽  
Vol 29 (4) ◽  
pp. 224-229 ◽  
Author(s):  
E. R. de Koning ◽  
M. J. Boogers ◽  
J. Bosch ◽  
M. de Visser ◽  
M. J. Schalij ◽  
...  
Keyword(s):  
Chest Pain ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Cardiac Symptoms ◽  
Emergency Medical ◽  
Time Period ◽  
Number Of Patients ◽  
St Elevation ◽  
Pain Patients ◽  
Hospital Cardiac Arrest

Abstract Objective To assess whether the COVID-19 lockdown in 2020 had negative indirect health effects, as people seem to have been reluctant to seek medical care. Methods All emergency medical services (EMS) transports for chest pain or out-of-hospital cardiac arrest (OHCA) in the Dutch region Hollands-Midden (population served > 800,000) were evaluated during the initial 6 weeks of the COVID-19 lockdown and during the same time period in 2019. The primary endpoint was the number of evaluated chest pain patients in both cohorts. In addition, the number of EMS evaluations of ST-elevation myocardial infarction (STEMI) and OHCA were assessed. Results During the COVID-19 lockdown period, the EMS evaluated 927 chest pain patients (49% male, age 62 ± 17 years) compared with 1041 patients (51% male, 63 ± 17 years) in the same period in 2019, which corresponded with a significant relative risk (RR) reduction of 0.88 (95% confidence interval (CI) 0.81–0.96). Similarly, there was a significant reduction in the number of STEMI patients (RR 0.52, 95% CI 0.32–0.85), the incidence of OHCA remained unchanged (RR 1.23, 95% CI 0.83–1.83). Conclusion During the first COVID-19 lockdown, there was a significant reduction in the number of patients with chest pain or STEMI evaluated by the EMS, while the incidence of OHCA remained similar. Although the reason for the decrease in chest pain and STEMI consultations is not entirely clear, more attention should be paid to the importance of contacting the EMS in case of suspected cardiac symptoms in possible future lockdowns.

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