scholarly journals Wellens’ syndrome: a case report with atypical features

2019 ◽  
Vol 89 (3) ◽  
Author(s):  
Giulia Ghizzoni ◽  
Edoardo Sciatti ◽  
Enrico Vizzardi ◽  
Ivano Bonadei ◽  
Davide Fabbricatore ◽  
...  
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Chest Pain ◽  
Unstable Angina ◽  
Type A ◽  
Type B ◽  
T Wave ◽  
Critical Stenosis ◽  
Left Anterior Descending Artery ◽  
Atypical Features

Wellens’ syndrome is a pattern of electrocardiographic T-wave changes seen in the precordial leads in patients with unstable angina. Two different patterns have been described. Type A presents with biphasic T-waves in V2-V3 and type B presents with symmetrical deep T-wave inversions in V2-V3. The etiology is related to a critical stenosis in the proximal left anterior descending artery (LAD). We describe a patient who presented at our emergency department with intermittent chest pain and showing Wellens’ pattern T-wave inversions in the precordial leads of the electrocardiogram. She was found to have 95% stenosis in mid LAD.

scholarly journals Wellens’ Syndrome, a case report of an electrocardiographic warning sign

2017 ◽  
Vol 5 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Yub Raj Sedhai ◽  
Aditya Singh Pawar ◽  
Priyanka T. Bhattacharya ◽  
Soney Basnyat
Keyword(s):  
Case Report ◽  
Chest Pain ◽  
Coronary Artery ◽  
Warning Sign ◽  
T Wave ◽  
Critical Stenosis ◽  
Free Interval ◽  
Drug Eluting ◽  
Electrocardiographic Changes ◽  
Wave Change

Introduction Wellens’ syndrome is described as a characteristic biphasic or symmetrical electrocardiographic T-wave inversions in precordial leads seen in a subset of patients with unstable angina. It is associated with critical stenosis of left anterior descending coronary artery. These patients have a high likelihood of progressing to acute myocardial infarction within a few days to weeks of onset of symptoms, thus it warrants an early invasive approach.Case Presentation: We present a 33-year-old otherwise healthy Indo-Jamaican male who presented with chest pain and characteristic electrocardiographic changes. Wellens’ syndrome was recognized. Emergent coronary angiography revealed 99% stenosis of proximal left anterior descending coronary artery. It was treated with a drug eluting stent.Conclusion: Electrocardiographic changes in Wellens’ syndrome are subtle and characteristically appear during chest pain free interval. It can be easily overlooked as non-specific ST, T wave change. Clinicians should be well aware of this subtle yet alarming electrocardiographic sign. This case report underlines the importance of recognizing the ominous electrocardiographic sign and its association with critical stenosis of the left anterior descending coronary artery.Journal of Advances in Internal Medicine 2016;05(01):19-23

scholarly journals Aurea diagnosis of pneumomediastinum. A case report

2020 ◽  
Vol 14 (3) ◽  
pp. 179-183
Author(s):  
Lucio Brugioni ◽  
Francesca De Niederhausern ◽  
Chiara Gozzi ◽  
Pietro Martella ◽  
Elisa Romagnoli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Chest Pain ◽  
Correct Diagnosis ◽  
Young Male ◽  
Differential Diagnoses ◽  
Diagnostic Process ◽  
Acute Aortic Syndrome ◽  
X Ray ◽  
Chest X Ray

Pericarditis and spontaneous pneumomediastinum are among the pathologies that are in differential diagnoses when a patient describes dorsal irradiated chest pain: if the patient is young, male, and long-limbed, it is necessary to exclude an acute aortic syndrome firstly. We present the case of a young man who arrived at the Emergency Department for chest pain: an echocardiogram performed an immediate diagnosis of pericarditis. However, if the patient had performed a chest X-ray, this would have enabled the observation of pneumomediastinum, allowing a correct diagnosis of pneumomediastinum and treatment. The purpose of this report is to highlight the importance of the diagnostic process.

scholarly journals A Case Report of Pulmonary Sarcoidosis: An Uncommon Cause of Chest Pain

2020 ◽  
Vol 4 (4) ◽  
pp. 645-648
Author(s):  
Justina Truong ◽  
John Ashurst
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Chest Pain ◽  
Pulmonary Sarcoidosis ◽  
Emergency Department Visits ◽  
Mediastinal Lymphadenopathy ◽  
Normal Limits ◽  
Emergency Department Management ◽  
Noncaseating Granulomas

Introduction: Chest pain is one of the most common causes of emergency department visits on an annual basis and carries a high degree of morbidity and mortality if managed inappropriately. Case Report: A 36-year-old male presented with four months of left-sided chest pain with dyspnea on exertion. Physical examination and laboratory values were within normal limits. Chest radiograph depicted diffuse interstitial nodular opacities throughout the lungs bilaterally with bilateral perihilar consolidations. Computed tomography of the chest demonstrated mid and upper lung nodularity with a perilymphatic distribution involving the central peribronchial vascular regions as well as subpleural and fissural surfaces causing conglomerate in the upper lobes centrally with associated hilar and mediastinal lymphadenopathy. The next day the patient underwent bronchoscopy with endotracheal ultrasound and transbronchial biopsies and pathology revealed non-necrotizing, well-formed granulomas embedded in dense hyaline sclerosis consistent with sarcoidosis. Discussion: Sarcoidosis is a multi-system granulomatous disease characterized by noncaseating granulomas on pathology. The worldwide epidemiology of sarcoidosis is currently unknown due to many patients being asymptomatic. However, patients may present with a persistent cough, dyspnea, or chest pain. Emergency department management should be aimed at minimizing long-term sequelae of the disease through obtaining labs and imaging after specialist consultation and arranging urgent follow-up. Conclusion: Although not one of the six high-risk causes of chest pain, sarcoidosis should be included in the differential to minimize the risk of long-term morbidity associated with advanced forms of the disease.

Don't get in a flap!: A case report of progression through the spectrum of an acute aortic syndrome

Vascular ◽  
2014 ◽  
Vol 22 (6) ◽  
pp. 454-457 ◽  
Author(s):  
Andrew MTL Choong ◽  
Saroj Das ◽  
Nicholas Mulrenan ◽  
Mohamad Hamady ◽  
Protip Bose
Keyword(s):  
Case Report ◽  
Chest Pain ◽  
Aortic Dissection ◽  
Vascular Surgery ◽  
Acute Type ◽  
Medical Team ◽  
Acute Aortic Syndrome ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Acute Aortic Syndromes

Purpose To present a single case that clearly demonstrates the progression through the whole spectrum of an acute aortic syndrome, from a solitary penetrating aortic ulcer (PAU) through to multiple PAUs with intra-mural haematoma (IMH) progression. The index images show that despite the clinical presentation of an acute type B aortic dissection, a classical dissection flap is never demonstrated in this patient and thus highlights the need for early input from vascular surgery for all potential acute aortic syndromes. Case report We present the case of a 71-year-old lady who attended the emergency department with hypertension and inter-scapular chest pain. Upon investigation with computed tomography aortography (CTA), she was found to have a solitary PAU only with minimal IMH. She did not demonstrate any classical radiological signs of acute type B aortic dissection. She was admitted under a medical team and her chest pain abated with no treatment. The treating medical team adjusted her anti-hypertensive medication and discharged her home with an urgent vascular surgical outpatient appointment for further follow-up and surveillance. We acknowledge that a preferred approach would have been, at least admission and close blood pressure monitoring, with a repeat CTA the next day. Two days later, she represented with further chest pain and on repeat CTA was found to have multiple PAUs and progression of the small IMH. She was then admitted under vascular surgery and subsequently transferred to the parent tertiary referral vascular surgical unit. Despite aggressive anti-hypertensive management, she had persistent intractable chest pain and was treated with a single thoracic stent graft. Completion angiography demonstrated total resolution of the PAUs. Conclusion This case along with index images demonstrates the whole spectrum of the acute aortic syndrome from a solitary PAU to multiple PAUs with IMH extension. Despite an eventual clinical picture of an acute type B aortic dissection, there was a notable absence of a classical dissection flap on any imaging. We recommend that all aortic pathologies should be at least discussed with and preferably managed by vascular surgeons. The absence of a classical dissection flap on imaging is not a contra-indication to emergent treatment with thoracic stent grafting and in select patients is actually the only therapy that will treat this pathology.

scholarly journals ATP stress MCE in evaluating coronary microvascular spasm: a case report

2021 ◽  
Author(s):  
Liu xuebing ◽  
Chun-Mei Li ◽  
Zhang Qing-Feng
Keyword(s):  
Case Report ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Myocardial Perfusion ◽  
Recovery Period ◽  
Peak Stress ◽  
Left Anterior Descending Artery ◽  
Microvascular Spasm

We report a case of coronary microvascular spasm assessed by ATP stress MCE (myocardial contrast electrocardiography). The patient had chest pain, but the coronary angiography was normal. There was apical ventricular septal perfusion delay before ATP stress, and the perfusion was significantly improved at peak stress, which was similar to the radionuclide myocardial perfusion characteristics of coronary microvascular spasm, In the recovery period, the flow spectrum resistance of the distal coronary artery of the left anterior descending artery increased compared with that before stress, which further confirmed that local coronary microvascular spasm was induced after vasodilation.

scholarly journals Pneumopericardium after Laparoscopic Hernia Repair Presents with ST-segment Changes: A Case Report

2021 ◽  
Vol 2 (5) ◽  
pp. 178-181
Author(s):  
Demi Galindo ◽  
Emily Martin ◽  
Douglas Franzen
Keyword(s):  
Pulmonary Embolism ◽  
Case Report ◽  
Chest Pain ◽  
Myocardial Ischemia ◽  
Hernia Repair ◽  
Laparoscopic Hernia Repair ◽  
T Wave ◽  
St Segment ◽  
Electrocardiogram Ecg ◽  
Unnecessary Intervention

Introduction: Although rare, iatrogenic cases of pneumopericardium have been documented following laparoscopic surgery and mechanical ventilation. Electrocardiogram (ECG) changes, including ST-segment depressions and T-wave inversions, have been documented in cases of pneumopericardium, and can mimic more concerning causes of chest pain including myocardial ischemia or pulmonary embolism. Case Report: This unique case describes a patient who presented with chest pain and ST-segment changes on ECG hours after a laparoscopic inguinal hernia repair and who was found to have pneumopericardium. Conclusion: While iatrogenic pneumopericardium is often self-limiting and rarely requires intervention, it is critical to differentiate pneumopericardium from other etiologies of chest pain, including myocardial ischemia and pulmonary embolism, to prevent unnecessary intervention.

scholarly journals Σύγκριση της δοκιμασίας σύνδεσης κοβαλτίου - αλβουμίνης και του υπερηχογραφήματος καρδιάς στην διαγνωστική ασθενών με θωρακικό πόνο

2013 ◽  
Author(s):  
Ευαγγελία Κουντάνα
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Unstable Angina ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Stress Test ◽  
Acute Chest Pain ◽  
Developed Countries ◽  
Coronary Syndrome ◽  
Sensitivity Specificity

Cardiovascular disease is the leading cause of mortality in developed countries andplaces a massive burden on healthcare services. Thousands of patients visit every yearthe Emergency Department (ED) with acute chest pain and a considerable proportionhas an acute coronary syndrome (ACS). In most cases, the electrocardiogram and thecommonly used biomarkers are not helpful in the early diagnosis of myocardialischemia.ObjectiveTo assess the role of ischemia modified albumin (IMA), a novel cardiac biomarker, inexcluding unstable angina (UA) in patients visiting the ED with acute chest pain. Thepredictive value of serum IMA concentrations were evaluated in comparison toechocardiogram.MethodsWe studied 33 patients (84.8% males, age 59.8±10.8 years) who presented at theAccident and Emergency Department with acute chest pain lasting < 3 h, normal ornon-diagnostic electrocardiogram and normal serum troponin and CK-MB levels.Serum IMA levels were determined and a comprehensive echocardiographic studywas performed. All patients were admitted to our Department of Cardiology and thediagnosis of UA was established with exercise or thallium stress test or with coronaryangiography.ResultsFive patients were eventually diagnosed with UA. The area under the curve for thediagnosis of unstable angina based on serum IMA levels was 0.193 (95% confidenceinterval 0.047-0.339, p < 0.05). Serum IMA levels ≥ 31,95 IU/ml had a sensitivity,specificity, positive and negative predictive value for the diagnosis of UA of 40.0%,28.6%, 9.1% and 72.7%, respectively. The sensitivity, specificity, positive andnegative predictive value of echocardiography for the diagnosis of UA was 60.0%,89.3%, 50.0% and 92.6%, respectively.Conclusion: Assessment of serum IMA levels in patients presenting with suspectedUA has comparable negative predictive value with echocardiography for excludingthe diagnosis of UA. Therefore, this biomarker appears to be useful in the diagnosisand stratification of risk in patients with ACS.

Electrocardiographic T-wave changes are more pronounced in type A than in type B men during mental work.

1986 ◽  
Vol 48 (3) ◽  
pp. 159-166 ◽  
Author(s):  
H Scher ◽  
L M Hartman ◽  
J J Furedy ◽  
R J Heslegrave
Keyword(s):  
Type A ◽  
Type B ◽  
Mental Work ◽  
T Wave
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