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 Extensively Thrombosed Ectatic Circumflex Coronary Artery Fistula Presenting as Acute Coronary Syndrome

2019 ◽  
Vol 15 (4) ◽  
pp. 316-319
Author(s):  
Nooraldaem Yousif ◽  
Mohammady Shahin ◽  
Robert Manka ◽  
Slayman Obeid
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Artery Fistula ◽  
Circumflex Artery ◽  
St Segment Elevation ◽  
Clear Cut ◽  
Coronary Syndrome ◽  
St Segment ◽  
Previous Medical History

Background: Coronary artery fistula (CAF) is an abnormal communication between the termination of a coronary artery or its branches and a cardiac chamber, a great vessel or other vascular structure. Symptomatic patients with large CAF should undergo surgical or percutanous closure of the fistula at the drainage site while still the debate on closing asymptomatic CAF and reopening symptomatic occluded CAF is ongoing. Case Summary: We are reporting a 30-year-old male patient with no previous medical history presented as non-ST segment elevation myocardial Infarction. Coronary angiography showed an entirely thrombosed ectatic circumflex artery with a suspicion of thrombosed coronary arterial fistula. In view of the ongoing ischemia in the setting of acute coronary syndrome; we tried to open percutaneously but all efforts were to no avail. Discussion: In this case report, we are sharing our experience in the management of this challenging case in view of the rarity of such peculiar clinical condition and the unfavourable presentation along with the lack of clear-cut Guideline and Consensus whether to/not to open such huge and immensely thrombosed symptomatic coronary artery fistula as well as the dilemma of choosing the best long-term medical treatment between antiplatelets vs anticoagulants in such young patient.

Approach to the Patient Presenting with Chest Pain

2017 ◽  
Author(s):  
John Tobias Nagurney
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Pulmonary Embolism ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Pain History

Caring for the emergency department patient with chest pain represents an important challenge to the emergency physician. Chest pain is the second most common presentation among all emergency department patients, accounting for approximately 6 million visits per year in the United States. Chest pain may represent a benign condition or a time-critical life threat; symptom overlap between benign and serious conditions can make an accurate chest pain diagnosis challenging. This review covers the pathophysiology, assessment, stabilization, diagnosis and treatment, and disposition and outcomes of chest pain. The figure shows an algorithm outlining the approach to the patient with chest pain. Tables list critical and noncritical diagnoses in patients presenting with chest pain: history, physical examination, and bedside testing; risk factors or associations for acute coronary syndrome, pulmonary embolism, and aortic dissection; characteristics of the chest pain story to diagnose acute coronary syndrome; ABCDEs of resuscitation for patients with unstable vital signs; critical and noncritical diagnoses in patients presenting with chest pain: history, diagnosis, and treatment; prevalence of pulmonary embolism in patients classified as low or high probability for this diagnosis by Wells score, modified Geneva score, and gestalt; commonly recognized pitfalls in the workup and diagnosis of chest pain in the emergency department; critical diagnoses in patients presenting with chest pain: history, disposition, and outcome; and summary of current recommendations. This review contains 1 highly rendered figure, 11 tables, and 54 references. Key words: acute coronary syndrome, acute myocardial infarction, anginal pain, aortic dissection, cardiac-related pain, chest pain, coronary artery disease, non–ST segment elevation myocardial infarction, pulmonary embolism, ST segment elevation myocardial infarction

scholarly journals On versus off-hour care of patients with acute coronary syndrome and persistent ST-segment elevation in certified German chest pain units

2016 ◽  
Vol 6 (1) ◽  
pp. 3-9 ◽  
Author(s):  
Frank Breuckmann ◽  
Matthias Hochadel ◽  
Thomas Voigtländer ◽  
Michael Haude ◽  
Claus Schmitt ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

scholarly journals Apparent ST elevation in right bundle branch block pseudo-mimicking myocardial infarction

2019 ◽  
Vol 7 ◽  
pp. 2050313X1982774 ◽  
Author(s):  
Itsuro Kazama ◽  
Toshiyuki Nakajima
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Right Bundle Branch Block ◽  
Cardiac Death ◽  
Close Monitoring ◽  
Bundle Branch Block ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
St Elevation

We report a case of right bundle branch block, in which the patient’s symptoms and the electrocardiogram findings mimicked those of acute coronary syndrome. In this case report, we stress the significance of apparent ST segment elevation in right bundle branch block. The differential diagnosis is important because right bundle branch block is often complicated with acute coronary syndrome. In addition, right bundle branch block with an ST segment elevation in the specific leads can be a predictor of sudden cardiac death. In such cases, close monitoring of the electrocardiogram findings and careful observation of the patient’s symptoms would be necessary.

scholarly journals Use of Coronary CT Angiography to Predict Obstructive Lesions in Patients with Chest Pain without Enzyme and ST-Segment Elevation

2021 ◽  
Vol 10 (22) ◽  
pp. 5442
Author(s):  
June-sung Kim ◽  
Youn-Jung Kim ◽  
Yo Sep Shin ◽  
Shin Ahn ◽  
Won Young Kim
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Prediction Model ◽  
Potential Candidate ◽  
Troponin Elevation ◽  
Significant Stenosis ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Pain Patients

It is challenging to rule out acute coronary syndrome among chest pain patients without both ST-segment elevation in electrocardiography and troponin elevation at emergency departments (ED). The purpose of this study was to develop a prediction model for rapidly determining the occurrence of significant stenosis in coronary computed tomography angiography (CCTA). Retrospective observational cohort study was conducted with 904 patients who had presented with chest pain without troponin elevation and ST-segment changes and underwent CCTA between January 2017 and December 2018. The primary endpoint was the presence of significant stenosis on CCTA, defined as narrowing above 70% diameter. The logistic regression model was used for development a new predictive model. One hundred and thirty-four patients (14.8%) were shown severe stenosis. The independent associated factors for significant stenosis were age ≥65 years, male, diabetes, history of acute coronary syndrome, and typical chest pain. Based these results, we developed a new prediction model. The area under the curve was 0.782 (95% confidence interval 0.742–0.822). Moreover, score of ≥5 was chosen as cut-off values with 86.6% sensitivity and 56.4% specificity. In conclusion, among chest pain patients without ST changes and troponin elevation, the new score will be helpful to identify potential candidate for CCTA such as patients with significant stenosis.

scholarly journals Electrocardiographic signs of acute myocardial infarction in left bundle branch block

2013 ◽  
Vol 66 (11-12) ◽  
pp. 503-506
Author(s):  
Igor Ivanov ◽  
Sonja Bugarski ◽  
Jadranka Dejanovic ◽  
Anastazija Stojsic-Milosavljevic ◽  
Jasna Radisic-Bosic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Sensitivity And Specificity ◽  
Left Bundle Branch Block ◽  
Bundle Branch Block ◽  
Duration Of Symptoms ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Introduction. Acute myocardial infarction is characterized by typical chest pain, electrocardiographic changes in terms of lesion and/or myocardial ischemia and increased cardiac enzymes. It is often difficult to make diagnosis in the presence of non-specific chest pain, the short duration of symptoms and electrocardiographic signs of a complete left bundle branch block. Literature Review. Many authors have tried to set the electrocardiographic criteria that can increase the possibility of correct diagnosis of acute myocardial infarction in such situations. The most widely used and recognized criterion is Sgarbossa scoring system that includes concordant ST segment elevation > 1 mm ST segment, disconcordant denivelation of ST segment > 1 mm in the leads V1-V3 and disconcordant ST segment elevation > 5 mm with acceptable sensitivity and specificity. In subsequent studies, the sensitivity and specificity increased by replacing the third criterion with ST/S ratio < -0.25. Conclusion. The knowledge of certain electrocardiographic signs in patients with acute coronary syndrome and left bundle branch block increases the chances of early diagnosis and the possibility of better and timely treatment.

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