scholarly journals Young male with chest pain and abnormal T-waves

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Amrithanand Velluridathil Thazhathidathil ◽  
Naman Agrawal ◽  
Roshan Mathew
Keyword(s):  
Chest Pain ◽  
Early Recognition ◽  
Young Male ◽  
Artery Occlusion ◽  
Ecg Changes ◽  
Diagnostic Challenge ◽  
Rare Presentation ◽  
Coronary Syndrome ◽  
T Wave ◽  
T Waves

Early recognition of ECG signs of acute coronary syndrome is essential for prompt treatment. But presentation with atypical ECG changes constitute a diagnostic challenge. We here report a case of 23-year-old male who presented with chest pain having atypical ECG changes with hyper-acute T waves called de Winters T wave. This is a rare presentation of patient with acute Left Anterior Descending artery occlusion. Some authors propose that de Winters pattern should be considered as “STEMI Equivalent”.

scholarly journals Ritka etiológiájú fiatalkori szívinfarktus

2015 ◽  
Vol 156 (25) ◽  
pp. 1020-1025
Author(s):  
Gábor Zoltán Nagy ◽  
Gábor Gerges ◽  
Kálmán Csapó ◽  
Erika Csengő ◽  
Károly Minik
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Aortic Dissection ◽  
Young Patients ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Left Main ◽  
Diagnostic Challenge ◽  
Total Occlusion ◽  
Coronary Syndrome

Chest pain is not uncommon among young patients below the age of 35 years, however, it is rarely caused by acute coronary syndrome. The rarity of coronary artery occlusion in this population can easily lead to diagnostic mistakes. The authors present the case history of a 19-year-old young female, who was admitted to the emergency department of a local hospital due to the sudden onset of chest pain and malaise. ST-segment elevation was seen on the electrocardiogram raising the possibility of aortic dissection, therefore, emergency thoracic computed tomographic scan was performed. This proved to be negative and the patient was transferred to the coronary care unit. Urgent coronarography was carried out, which revealed the total occlusion of the left main coronary artery. The occluded artery was successfully opened with percutaneous coronary intervention, but despite revascularisation the patient died on the second postoperative day due to asystole. Autopsy revealed thrombotic embolization of the left main artery with consequent extensive haemorrhagic necrosis, involving almost the whole left ventricle. The source of embolization was not found. The authors note that left coronary artery occlusion in young patients can be a diagnostic challenge, because symptoms can be mistaken with aortic dissection or pulmonary embolism. Orv. Hetil., 2015, 156(25), 1020–1025.

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 EFFECT OF OXYGEN SUPPLEMENTATION ON LOW LANDERS ON ASCENDING TO HIGH ALTITUDE WITH PRECORDIAL ECG CHANGES WITHOUT HIGH ALTITUDE ILLNESS

2020 ◽  
pp. 1-4
Author(s):  
Surabhi Venkata Satya Krishna ◽  
MG Vishnoi ◽  
S. Nagamanju
Keyword(s):  
High Altitude ◽  
Hypobaric Hypoxia ◽  
Pulmonary Vasculature ◽  
Ecg Changes ◽  
Oxygen Supplementation ◽  
Coronary Syndrome ◽  
T Wave ◽  
Wave Inversion ◽  
High Altitude Illness ◽  
Pressure Changes

High altitude syndromes are illnesses attributed directly to hypobaric hypoxia. Hypobaric Hypoxic pressure changes in the right side of the heart with ECG changes in right precordial leads are seen in cases like High Altitude Pulmonary Edema (HAPE), Pulmonary Thormboembolism (PTE) and thrombotic cause in acute coronary syndrome (ACS). Cases of these mimics with T wave inversion in precordial chest leads are seen in low landers on induction into high altitude without any high altitude illness, ACS or PTE. These findings may reflect asymptomatic pressure changes in the heart and pulmonary vasculature due to hypobaric hypoxia of high altitude to the point where they are not manifested. High altitude environment is itself being a procoagulant state compounded with hypobaric hypoxia, if these changes are not addressed in time and not treated with oxygen supplementation, these individuals may present at a later stage with HAPE or SAMS. We hypothesized that oxygen supplementation can reverse these changes. Intervention study with oxygen supplementation @ 6/min intermittently over 12 hr/day was given in all those individuals who have T wave inversion in precordial ECG meeting inclusion criteria over a week. The study was conducted at peripheral hospital 11000ft in Himalayan ranges over a period of 06 months. 100 % of cases had shown normalization of T waves in response to oxygen supplementation. However 02 individuals had recurrence of ECG changes and they were deinducted to plains. None of them developed high altitude illness over next 06 months of followup.

scholarly journals Situs Inversus: Inferior-Lateral ST-Elevation Myocardial Infarction on Right-Sided Electrocardiogram

2019 ◽  
Vol 3 (3) ◽  
pp. 307-309
Author(s):  
Mohamed Hamam ◽  
Howard Klausner
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Health Risks ◽  
St Elevation Myocardial Infarction ◽  
Diagnostic Challenge ◽  
Coronary Syndrome ◽  
Anatomical Anomaly ◽  
Syndrome Diagnosis ◽  
St Elevation ◽  
The Right

Dextrocardia is a rare anatomical anomaly in which the heart is located in the patient’s right hemithorax with its apex directed to the right. Although it usually does not pose any serious health risks, patients with undiagnosed dextrocardia present a diagnostic challenge especially in those presenting with chest pain. Traditional left-sided electrocardiograms (ECG) inadequately capture the electrical activity of a heart positioned in the right hemithorax, which if unnoticed could delay or even miss an acute coronary syndrome diagnosis. Here, we present a case of a patient with dextrocardia presenting with chest pain and diagnosed with ST-elevation myocardial infarction using a right-sided ECG.

scholarly journals Cardiac magnetic resonance assessment of diastolic dysfunction in acute coronary syndrome

2017 ◽  
Vol 45 (6) ◽  
pp. 1680-1692 ◽  
Author(s):  
Shah M. Azarisman ◽  
Karen S Teo ◽  
Matthew I Worthley ◽  
Stephen G Worthley
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Chest Pain ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Diastolic Dysfunction ◽  
Imaging Techniques ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Acute Setting ◽  
Coronary Syndrome

Chest pain is an important presenting symptom. However, few cases of chest pain are diagnosed as acute coronary syndrome (ACS) in the acute setting. This results in frequent inappropriate discharge and major delay in treatment for patients with underlying ACS. The conventional methods of assessing ACS, which include electrocardiography and serological markers of infarct, can take time to manifest. Recent studies have investigated more sensitive and specific imaging modalities that can be used. Diastolic dysfunction occurs early following coronary artery occlusion and its detection is useful in confirming the diagnosis, risk stratification, and prognosis post-ACS. Cardiac magnetic resonance provides a single imaging modality for comprehensive evaluation of chest pain in the acute setting. In particular, cardiac magnetic resonance has many imaging techniques that assess diastolic dysfunction post-coronary artery occlusion. Techniques such as measurement of left atrial size, mitral inflow, and mitral annular and pulmonary vein flow velocities with phase-contrast imaging enable general assessment of ventricular diastolic function. More novel imaging techniques, such as T2-weighted imaging for oedema, T1 mapping, and myocardial tagging, allow early determination of regional diastolic dysfunction and oedema. These findings may correspond to specific infarcted arteries that may be used to tailor eventual percutaneous coronary artery intervention.

scholarly journals Eficácia de protocolos clínicos para o tratamento da dor torácica em serviços de urgência

2020 ◽  
Vol 10 (32) ◽  
pp. 288-294
Author(s):  
Rafael Mondego Fontenele ◽  
Tatiana De Almeida Souza ◽  
Darly Serra Cutrim ◽  
Joseane Moura Guedes ◽  
Josiel Freitas do Nascimento ◽  
...  
Keyword(s):  
Chest Pain ◽  
Causes Of Death ◽  
Early Recognition ◽  
Hospital Environment ◽  
Clinical Protocols ◽  
Review Of The Literature ◽  
Emergency Relief ◽  
Coronary Syndrome ◽  
Emergency Units ◽  
Coronary Syndromes

A dor torácica pode estar relacionada à síndrome coronariana, uma das principais causas de morte no Brasil. Os protocolos clínicos são diretrizes que visam o reconhecimento precoce e tratamento de agravos em rotina aprovada pela unidade assistencial. O objetivo do presente estudo foi identificar a eficácia de protocolos clínicos para o tratamento de dor torácica em unidades de urgência. Tratou-se uma revisão integrativa da literatura realizada nas bases científicas da Scielo e Lilacs a partir da combinação de descritores em ciências da saúde obtidos através do portal da Biblioteca Virtual em Saúde. Os principais exames realizados são eletrocardiograma, angiotomografia de coronárias e a cintilografia para a elucidação diagnóstica de síndromes coronarianas na presença de dor torácica. Concluiu-se que a incorporação de protocolos clínicos no ambiente hospitalar garante a segurança do paciente, orienta e direciona as condutas médicas para a prevenção de complicações como o óbito.Descritores: Dor no Peito, Socorro de Urgência, Emergências, Protocolos. Efficacy of clinical protocols for the treatment of chest pain in emergency servicesAbstract: Chest pain may be related to coronary syndrome, one of the main causes of death in Brazil. The clinical protocols are guidelines that aim at the early recognition and treatment of injuries in a routine approved by the care unit. The objective of the present study was to identify the efficacy of clinical protocols for the treatment of chest pain in emergency units. An integrative review of the literature on the scientific bases of Scielo and Lilacs was done based on the combination of descriptors in health sciences obtained through the Virtual Health Library portal. The main exams were electrocardiogram, coronary angiotomography and scintigraphy for the diagnostic elucidation of coronary syndromes in the presence of chest pain. It was concluded that the incorporation of clinical protocols in the hospital environment guarantees the patient's safety, directs and directs the medical conducts for the prevention of complications such as death.Descriptor: Chest Pain, Emergency Relief, Emergencies, Protocols. Eficacia de protocolos clínicos para el tratamiento del dolor torácico en servicios de urgenciaResumen: El dolor torácico puede estar relacionado con el síndrome coronario, una de las principales causas de muerte en Brasil. Los protocolos clínicos son directrices que apuntan al reconocimiento precoz y tratamiento de agravios en rutina aprobada por la unidad asistencial. El objetivo del presente estudio fue identificar la eficacia de protocolos clínicos para el tratamiento del dolor torácico en unidades de urgencia. Se trató una revisión integrativa de la literatura realizada en las bases científicas de Scielo y Lilacs a partir de la combinación de descriptores en ciencias de la salud obtenidos a través del portal de la Biblioteca Virtual en Salud. Los principales exámenes realizados son electrocardiograma, angiotomografía de coronarias y la centellografía para la elucidación diagnóstica de síndromes coronarios en presencia de dolor torácico. Se concluyó que la incorporación de protocolos clínicos en el ambiente hospitalario garantiza la seguridad del paciente, orienta y dirige las conductas médicas para la prevención de complicaciones como el óbito.Descriptores: Dolor em el Pecho, Socorro de Urgencia, Urgencias Médicas, Protocolos.

scholarly journals Uncommon Variant of Wellens’ Syndrome: A Case Report and Review of Literature

2017 ◽  
Vol 6 (4) ◽  
Author(s):  
Layal Mansour MD ◽  
Elie Chammas MD, FESC, FACC ◽  
Fida Charif MD ◽  
Mohamad Jihad Mansour
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Troponin I ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
T Wave ◽  
Wave Inversion ◽  
Risk Of Mortality ◽  
Electrocardiogram Ecg ◽  
T Waves

<p><em>A 48-year-old male was admitted to the emergency department because of intermittent chest pain of 2 days duration. At the time of examination, he was pain-free. An electrocardiogram (ECG) showed biphasic T waves in leads V2 to V6. Troponin-I level was negative. During his transfer to the cardiac catheterization laboratory, he had a short episode of chest pain. His ECG was normal. Despite the unusual extension of biphasic T waves to the lateral precordial leads, the condition was recognized as Wellens’ syndrome, which typically associates biphasic or deep symmetric T wave inversion in leads V2 and V3 during pain-free periods with a critical stenosis in the proximal left anterior descending artery. The syndrome is uncommon to medical practice but should be recognized immediately in the emergency department because it represents a pre-infarction stage and carries a high risk of mortality. </em><em></em></p>

scholarly journals Two case reports of Wellens’ syndrome

2018 ◽  
Vol 46 (11) ◽  
pp. 4845-4851
Author(s):  
Xiqiang Wang ◽  
Jingjing Sun ◽  
Zhuokun Feng ◽  
Yuan Gao ◽  
Chaofeng Sun ◽  
...  
Keyword(s):  
Wide Spectrum ◽  
Case Reports ◽  
Clinical Manifestations ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
T Wave ◽  
Wave Inversion ◽  
Electrocardiographic Changes ◽  
St Segments ◽  
T Waves

Wellens’ syndrome is characterised by particular changes in electrocardiogram (ECG) precordial lead T-waves accompanied by proximal stenosis of the left anterior descending (LAD) artery. Two cases of electrocardiographic changes associated with Wellens’ syndrome are presented here. Case 1, a 55-year-old female, was transferred to the First Affiliated Hospital of Xi’an Jiaotong University with intermittent and laborious angina pectoris. Her first ECG on admission revealed T-wave inversion in leads V1–V3 and biphasic T-waves in V4. Case 2, an 85-year-old female, presented with dyspnoea and paroxysmal chest pain. Her admission ECG displayed asymmetrical T-wave inversion in leads V1–V3, I, and aVL, and depressed ST segments in leads V2–V5. In this patient, drug-eluting stents were placed on a LAD artery lesion and right coronary artery occlusion. The potential of ECGs to aid decision-making in severe myocardial infarction is straightforward, particularly in patients with characteristic ECGs, however, Wellens’ syndrome has a wide spectrum of clinical manifestations and the ECG patterns may manifest itself persistently over a period of weeks. Therefore, ECG parameters should be combined with coronary angiography to confirm the presence of lesions.

scholarly journals Chest pain and an abnormal chest X-ray – a case report

2013 ◽  
Vol 12 (4) ◽  
pp. 227-229
Author(s):  
Nicholas Smallwood ◽  
◽  
Sarah Perrio ◽  
Keyword(s):  
Chest Pain ◽  
Common Symptom ◽  
C Reactive Protein ◽  
Diagnostic Challenge ◽  
Reactive Protein ◽  
Coronary Syndrome ◽  
Acute Medical Unit ◽  
Abnormal Chest ◽  
Chest X Ray ◽  
Early Surgical Intervention

Chest pain is a common symptom amongst patients presenting to the acute medical unit, and presents a diagnostic challenge. We present the case of a previously healthy 65 year old year old gentleman with chest pain and subsequent vomiting, treated initially as an acute coronary syndrome, despite normal ECG and troponin. Chest radiograph revealed left basal consolidation with an effusion, suggesting pneumonia. The absence of symptoms of respiratory infection along with a normal C-reactive protein level led to further investigation with CT. This revealed evidence of oesophageal rupture (Boerhaave’s syndrome). Despite early surgical intervention our patient suffered a number of complications and continues his recovery in hospital three months post presentation.

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