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Seghda TAA, Dan Naibé T, Dabiré YE, Nacanabo MW, Damoué Seghda S, Dah DC, Mireille AL, Yaméogo NV, Millogo GRC, Tall Thiam A, Flork L, Samadoulougou AK, Zabsonré P. [Performance of the 4-level probability score 4PEPS for the diagnosis of pulmonary embolism in a sub-Saharan African population : Data from the Pulmonary Embolism Registry of the Bogodogo University Hospital, Burkina Faso]. Ann Cardiol Angeiol (Paris) 2024; 73:101798. [PMID: 39317081 DOI: 10.1016/j.ancard.2024.101798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/19/2024] [Accepted: 07/28/2024] [Indexed: 09/26/2024]
Abstract
OBJECTIVE To evaluate the performance of the 4PEPS score in the diagnosis of pulmonary embolism at the University Hospital of Bogodogo from January 1, 2021 to July 31, 2023. METHODOLOGY This was a cross-sectional descriptive and analytical diagnostic study, running from January 1, 2021 to July 31, 2023. It took place in the infectious and tropical diseases departments, including a pneumology unit and a cardiology unit, of the Bogodogo University Hospital. Patients of both sexes with suspected pulmonary embolism who had undergone CT scan were included. The 4PEPS score was calculated and dichotomized into probable and improbable. It thus constituted the diagnostic test. CT scan was the gold standard. The accuracy of the diagnostic test was judged by the area under the ROC curve. An area under the curve between 0.70 and 1 would mean that the score was moderately informative to perfect. RESULTS Our study included 472 patients with suspected pulmonary embolism out of a total population of 1228 patients. Hospital prevalence was 21.7%. The mean age of patients was 54.3 years. Females accounted for 52.1% of cases, with a sex ratio of 0.93. The prevalence of pulmonary embolism in the different probability levels of the 4PEPS score was 13.3% for the very low level, 11.7% for the low level, 84.6% for the intermediate level and 93.3% for the high level. Sensitivity and specificity were 92.1% and 86.82% respectively. The positive and negative predictive values were 90.1% and 89.4% respectively. The area under the ROC curve was 0.91. CONCLUSION In our study, the 4PEPS score showed good negative and positive predictive values. The use of this score will enable practitioners faced with diagnostic difficulties to make therapeutic decisions, reducing inappropriate prescriptions for thoracic angioscan.
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Affiliation(s)
| | - Temoua Dan Naibé
- Service de cardiologie de l'Hôpital Général de Référence Nationale de Ndjamena, Tchad
| | | | | | - Sandrine Damoué Seghda
- Service de Maladies Infectieuses/Tropicales/unité de Pneumologie CHU de Bogodogo, Ouagadougou, Burkina Faso
| | | | | | | | | | - Anna Tall Thiam
- Service de cardiologie CHU Yalgado/Ouédraogo, Ouagadougou, Burkina Faso
| | - Laurence Flork
- Service de cardiologie, Centre hospitalier Guy-Thomas de Riom, Auvergne, France
| | | | - Patrice Zabsonré
- Service de cardiologie CHU Yalgado/Ouédraogo, Ouagadougou, Burkina Faso
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Chen YH, Zhu XY, Fan LH, Xu HF. Pulmonary embolism in patients with chronic coronary syndrome masquerading as acute coronary syndrome: a case report and literature review. BMC Cardiovasc Disord 2024; 24:331. [PMID: 38951773 PMCID: PMC11218115 DOI: 10.1186/s12872-024-03998-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 06/21/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Pulmonary embolisms (PEs) exhibit clinical features similar to those of acute coronary syndrome (ACS), including electrocardiographic abnormalities and elevated troponin levels, which frequently lead to misdiagnoses in emergency situations. CASE PRESENTATION Here, we report a case of PE coinciding with chronic coronary syndrome in which the patient's condition was obscured by symptoms mimicking ACS. A 68-year-old female with syncope presented to the hospital. Upon admission, she was found to have elevated troponin levels and an electrocardiogram showing ST-segment changes across multiple leads, which initially led to a diagnosis of ACS. Emergency coronary arteriography revealed occlusion of the posterior branches of the left ventricle of the right coronary artery, but based on the complexity of the intervention, the occlusion was considered chronic rather than acute. On the 3rd day after admission, the patient experienced recurrent chest tightness and shortness of breath, which was confirmed as acute PE by emergency computed tomography pulmonary angiography. Following standardized anticoagulation treatment, the patient improved and was subsequently discharged. CONCLUSIONS This case report highlights the importance of recognizing the nonspecific features of PE. Clinicians should be vigilant when identifying other clinical features that are difficult to explain accompanying the expected disease, and it is necessary to carefully identify the causes to prevent missed diagnoses or misdiagnoses.
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Affiliation(s)
- Yun-Hu Chen
- Cardiovascular Department, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215400, China.
| | - Xing-Yu Zhu
- Clinical Pharmacy Department, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215400, China
| | - Li-Hua Fan
- Cardiovascular Department, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215400, China
| | - Hong-Feng Xu
- Cardiovascular Department, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215400, China
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Jiang J, Jin C, Yu S, Cheng Y, Wu Y, Ma H. Persistent convex ST-segment elevation in a patient with a history of prior intracerebral haemorrhage. ESC Heart Fail 2024; 11:1777-1784. [PMID: 38321818 PMCID: PMC11098661 DOI: 10.1002/ehf2.14703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/31/2023] [Accepted: 01/09/2024] [Indexed: 02/08/2024] Open
Abstract
Management of patients with acute chest pain poses a significant challenge in identifying those requiring urgent coronary reperfusion. Electrocardiogram (ECG) constitutes the cornerstone in making prompt clinical decisions by identifying ST-segment elevation, commonly associated with ST-segment elevation myocardial infarction. It is important to note that ST-segment elevation can also be a manifestation of various cardiac and non-cardiac conditions, from acute myocarditis, early repolarization syndrome, acute pericarditis, and left bundle branch block to unknown origins. The similarity of ECG changes among these conditions complicates clinical differential diagnosis, necessitating a detailed medical history and thorough examinations. Here, we presented a case of a 52-year-old female with chest pain and unidentified convex ST-segment elevation. Considering the negative emergent coronary angiography results, normal echocardiography, and long-lasting ST-segment elevation for the following 1 year, the final diagnosis was non-myocardial infarction, probably related to a prior cerebral haemorrhage.
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Affiliation(s)
- Jian Jiang
- The Second Affiliated Hospital (Quzhou Campus), School of MedicineZhejiang UniversityQuzhouChina
- Department of CardiologyThe Second People's Hospital of QuzhouQuzhouChina
| | - Chengjiang Jin
- Department of Cardiology, The Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
- State Key Laboratory of Transvascular Implantation DevicesHangzhouChina
- Cardiovascular Key Laboratory of Zhejiang ProvinceHangzhouChina
| | - Shuo Yu
- Department of Anesthesiology, The Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
| | - Yunxian Cheng
- The Second Affiliated Hospital (Quzhou Campus), School of MedicineZhejiang UniversityQuzhouChina
- Department of CardiologyThe Second People's Hospital of QuzhouQuzhouChina
| | - Yinggang Wu
- The Second Affiliated Hospital (Quzhou Campus), School of MedicineZhejiang UniversityQuzhouChina
- Department of CardiologyThe Second People's Hospital of QuzhouQuzhouChina
| | - Hong Ma
- Department of Cardiology, The Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
- State Key Laboratory of Transvascular Implantation DevicesHangzhouChina
- Cardiovascular Key Laboratory of Zhejiang ProvinceHangzhouChina
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4
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Bahreini Z, Kamali M, Kheshty F, Bazrafshan Drissi H, Boogar SS, Bazrafshan M. Differentiating electrocardiographic indications of massive and submassive pulmonary embolism: A cross-sectional study in Southern Iran from 2015 to 2020. Clin Cardiol 2024; 47:e24252. [PMID: 38465696 PMCID: PMC10926280 DOI: 10.1002/clc.24252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Although using electrocardiogram (ECG) for pulmonary embolism (PE) risk stratification has shown mixed results, it is currently used as supplementary evidence in risk stratification. This cross-sectional study aimed to assess and compare ECG findings of massive and submassive PE versus segmental PE. METHODS This cross-sectional study included 250 hospitalized patients with a confirmed diagnosis of acute PE from 2015 to 2020 in Southern Iran. Demographic variables, clinical data, troponin levels, on-admission ECG findings, echocardiography findings, and ECG findings 24 h after receiving anticoagulants or thrombolytics were extracted. RESULTS Patients diagnosed with submassive or massive PE exhibited significantly higher rates of right axis deviation (p = .010), abnormal ST segment (p < .0001), S1Q3T3 pattern (p < .0001), inverted T wave in leads V1-V3 (p < .0001), inverted T wave in leads V4-V6 (p < .0001), and inverted T wave in leads V1-V6 (p < .0001). In a multivariable model, inverted T wave in leads V1-V3, inverted T wave in leads V4-V6, pulse rate, and positive troponin test were the statistically independent variables for predicting submassive or massive PE. Furthermore, inverted T wave in leads V1-V3 (sensitivity: 85%, specificity: 95%, accuracy: 93%, AUC: 0.902) and troponin levels (sensitivity: 72%, specificity: 86%, accuracy: 83%, AUC: 0.792) demonstrated the best diagnostic test performance for discriminating submassive or massive PE from segmental PE. CONCLUSION In addition to clinical rules, ECG can serve as an ancillary tool for assessing more invasive testing and earlier aggressive treatments among patients with PE, as it can provide valuable information for the diagnosis and risk stratification of submassive or massive PE.
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Affiliation(s)
- Zahra Bahreini
- Cardiovascular Research CenterShiraz University of Medical SciencesShirazIran
| | - Maliheh Kamali
- Cardiovascular Research CenterShiraz University of Medical SciencesShirazIran
| | - Fatemeh Kheshty
- Cardiovascular Research CenterShiraz University of Medical SciencesShirazIran
| | | | | | - Mehdi Bazrafshan
- Cardiovascular Research CenterShiraz University of Medical SciencesShirazIran
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Jia Z, Liu T, Che J. An Older Patient With Chest Pain-Diagnostic Traps. JAMA Intern Med 2023; 183:1263-1264. [PMID: 37747722 DOI: 10.1001/jamainternmed.2023.2461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
This case report describes an older patient with persistent chest pain, recent hospitalization for SARS-CoV-2 infection, and previous kidney transplantation.
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Affiliation(s)
- Ziheng Jia
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Jingjin Che
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
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Chyu KY, Shah PK. Electrocardiograms in Critical Care Cardiology: Is it Acute Coronary Syndrome? JACC Case Rep 2022; 4:1394-1398. [PMID: 36388710 PMCID: PMC9663980 DOI: 10.1016/j.jaccas.2022.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/30/2022] [Indexed: 06/16/2023]
Abstract
Patients with critical illness may present with electrocardiogram (ECG) findings difficult for physicians to distinguish them from acute coronary syndrome. This article provides three cases of such clinical scenarios. Examples of ECGs and their clinical characteristics and significance are discussed. (Level of Difficulty: Beginner.).
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Affiliation(s)
| | - Prediman K. Shah
- Address for correspondence: Dr. Prediman K. Shah, Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, 127 South San Vicente Boulevard, Suite A-3307, Los Angeles, California 90048, USA.
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El-Azrak M, Boutaybi M, Mouedder F, EL Ouafi N, Ismaili N. Massive pulmonary embolism with ST-segment elevation mimicking an isolated right ventricular myocardial infarction in a patient with COVID-19 pneumonia: Case report. Ann Med Surg (Lond) 2022; 84:104943. [PMCID: PMC9671607 DOI: 10.1016/j.amsu.2022.104943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/25/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022] Open
Abstract
Pulmonary embolism (PE) is a great simulator; It mimics step by step its main differential diagnosis which is myocardial infarction. Its clinical and electrical manifestations are unspecific. Rarely, an ST-segment elevation can occur making the diagnosis more difficult. Recognizing such an uncommon electrocardiographic (ECG) pattern is of an important relevance to lead to a prompt and suitable therapeutic management. In our paper, we discuss a 68 years-old man case who presents with dyspnea and chest pain with ST-segment elevation in V1, aVR, DIII, and right-sided leads suggestive of isolated right ventricular infarction, admitted in a stable hemodynamical status which rapidly deteriorated. Echocardiographic assessment has shown signs of acute pulmonary heart disease with the presence of the specific McConnell's sign. A computed tomography pulmonary angiogram was performed revealing massive bilateral PE that benefited from thrombolytic therapy with alteplase with a remarkable following and regression of the ST-segment elevation. To our knowledge, this is the first case report of massive PE presenting with these ECG findings in the context of COVID 19 pneumonia, of which practitioners should be aware to better orient diagnosis and therapeutic management.
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Nägele MP, Flammer AJ. Heart Failure After Right Ventricular Myocardial Infarction. Curr Heart Fail Rep 2022; 19:375-385. [PMID: 36197627 DOI: 10.1007/s11897-022-00577-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 10/10/2022]
Abstract
PURPOSE OF REVIEW Heart failure (HF) after right ventricular myocardial infarction (RVMI) is common and complicates its clinical course. This review aims to provide a current overview on the characteristic features of RV failure with focus on acute management. RECENT FINDINGS While HF after RVMI is classically seen after acute proximal right coronary artery occlusion, RV dysfunction may also occur after larger infarctions in the left coronary artery. Because of its different anatomy and physiology, the RV appears to be more resistant to permanent infarction compared to the LV with greater potential for recovery of ischemic myocardium. Hypotension and elevated jugular pressure in the presence of clear lung fields are hallmark signs of RV failure and should prompt confirmation by echocardiography. Management decisions are still mainly based on small studies and extrapolation of findings from LV failure. Early revascularization improves short- and long-term outcomes. Acute management should further focus on optimization of preload and afterload, maintenance of sufficient perfusion pressures, and prompt management of arrhythmias and concomitant LV failure, if present. In case of cardiogenic shock, use of vasopressors and/or inotropes should be considered along with timely use of mechanical circulatory support (MCS) in eligible patients. HF after RVMI is still a marker of worse outcome in acute coronary syndrome. Prompt revascularization, careful medical therapy with attention to the special physiology of the RV, and selected use of MCS provide the RV the time it needs to recover from the ischemic insult.
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Affiliation(s)
- Matthias P Nägele
- University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, CH-8091, CardiologyZurich, Switzerland
| | - Andreas J Flammer
- University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, CH-8091, CardiologyZurich, Switzerland.
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Zheng B, Bian F, Li J, Xu H, Wang J. A potential diagnostic pitfall in ST elevation: Acute pulmonary embolism or ST-segment elevation myocardial infarction. Ann Noninvasive Electrocardiol 2021; 27:e12928. [PMID: 34861070 PMCID: PMC9107082 DOI: 10.1111/anec.12928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/28/2022] Open
Abstract
The diagnosis of acute pulmonary embolism (APE) is a great challenge for physicians due to its nonspecific symptoms, and often missed or misdiagnosed as acute coronary syndrome. Electrocardiographic (ECG) abnormalities are seen in majority of patients with APE. Recently, APE with ST‐segment elevation (STE) in leads V1–V3/V4, mimicking ST‐segment elevation myocardial infarction (STEMI), has been described. However, coronary angiography showed that the patient's coronary arteries were mostly normal. Herein, we describe a case of APE presenting with STE in V1–V4, along with severe stenosis of the left anterior descending (LAD) artery.
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Affiliation(s)
- Bo Zheng
- Department of Cardiology, Binzhou Medical University Hospital, Binzhou City, Shandong, China
| | - Fei Bian
- Department of Cardiology, Binzhou Medical University Hospital, Binzhou City, Shandong, China
| | - Jingsen Li
- Department of Cardiology, Binzhou Medical University Hospital, Binzhou City, Shandong, China
| | - Huipu Xu
- Department of Cardiology, Binzhou Medical University Hospital, Binzhou City, Shandong, China
| | - Jian Wang
- Department of Cardiology, Binzhou Medical University Hospital, Binzhou City, Shandong, China
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Sessa F, Esposito M, Messina G, Di Mizio G, Di Nunno N, Salerno M. Sudden Death in Adults: A Practical Flow Chart for Pathologist Guidance. Healthcare (Basel) 2021; 9:870. [PMID: 34356248 PMCID: PMC8307931 DOI: 10.3390/healthcare9070870] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 12/27/2022] Open
Abstract
The medico-legal term "sudden death (SD)" refers to those deaths that are not preceded by significant symptoms. SD in apparently healthy individuals (newborn through to adults) represents a challenge for medical examiners, law enforcement officers, and society as a whole. This review aims to introduce a useful flowchart that should be applied in all cases of SD. Particularly, this flowchart mixes the data obtained through an up-to-date literature review and a revision of the latest version of guidelines for autopsy investigation of sudden cardiac death (SCD) in order to support medico-legal investigation. In light of this review, following the suggested flowchart step-by-step, the forensic pathologist will be able to apply all the indications of the scientific community to real cases. Moreover, it will be possible to answer all questions relative to SD, such as: death may be attributable to cardiac disease or to other causes, the nature of the cardiac disease (defining whether the mechanism was arrhythmic or mechanical), whether the condition causing SD may be inherited (with subsequent genetic counseling), the assumption of toxic or illicit drugs, traumas, and other unnatural causes.
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Affiliation(s)
- Francesco Sessa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Massimiliano Esposito
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.E.); (M.S.)
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Giulio Di Mizio
- Forensic Medicine, Department of Law, Economy and Sociology, Campus “S. Venuta”, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Nunzio Di Nunno
- Department of History, Society and Studies on Humanity, University of Salento, 73100 Lecce, Italy;
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.E.); (M.S.)
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11
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An X, Fu R, Zhao Z, Ni X, Xiong C, Cheng X, Liu Z. Leriche syndrome in a patient with acute pulmonary embolism and acute myocardial infarction: a case report and review of literature. BMC Cardiovasc Disord 2020; 20:26. [PMID: 31952498 PMCID: PMC6966837 DOI: 10.1186/s12872-019-01288-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 11/29/2019] [Indexed: 01/12/2023] Open
Abstract
Background Both acute myocardial infarction and acute pulmonary embolism are distinct medical urgencies while they may conincide. Leriche’s syndrome is a relatively rare aortoiliac occlusive disease characterized by claudication, decreased femoral pulses, and impotence. We present the first case of concomitant acute pulmonary embolism, acute myocardial infarction, and Leriche syndrome. Case presentation A 56-year-old male with a history of intermittent claudication was admitted for evaluating the sudden onset of chest pain. Elevated serum troponin level, sustained high D-dimer level, ST-T wave changes on electrocardiogram, and segmental wall motion abnormality of the left ventricle on transthoracic echocardiography were noted. Pulmonary Computed Tomography Angiogram revealed multiple acute emboli. Aortic Computed Tomography Angiogram spotted complete obstructions of the subrenal aorta and bilateral common iliac arteries with collateral circulation, maintaining the vascularization of internal and external iliac arteries. We stated the diagnosis of acute pulmonary embolism and Leriche syndrome and initiated oral anticoagulation. However, Q waves on electrocardiogram and wall motion abnormality on echocardiography persisted after embolus dissolved successfully. Coronary computed tomography angiogram found coronary arterial plaques while myocardial Positron Emission Tomography detected decreased viable myocardium of the left ventricle. We subsequently ratified the diagnosis of concurrent acute pulmonary embolism, acute myocardial infarction, and Leriche syndrome. The patient was discharged and has been followed up at our center. Conclusion We described the first concurrence of acute pulmonary embolism, acute myocardial infarction, and Leriche syndrome.
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Affiliation(s)
- Xuanqi An
- State Key Laboratory of Cardiovascular Disease, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing, 100037, People's Republic of China
| | - Rui Fu
- State Key Laboratory of Cardiovascular Disease, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing, 100037, People's Republic of China
| | - Zhihui Zhao
- State Key Laboratory of Cardiovascular Disease, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing, 100037, People's Republic of China
| | - Xinhai Ni
- State Key Laboratory of Cardiovascular Disease, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing, 100037, People's Republic of China
| | - Changming Xiong
- State Key Laboratory of Cardiovascular Disease, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing, 100037, People's Republic of China
| | - Xiansheng Cheng
- State Key Laboratory of Cardiovascular Disease, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing, 100037, People's Republic of China
| | - Zhihong Liu
- State Key Laboratory of Cardiovascular Disease, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing, 100037, People's Republic of China.
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Davis WT, Montrief T, Koyfman A, Long B. Response: Pulmonary embolism and shunt in acute myocardial infarction. Am J Emerg Med 2019; 37:1592. [DOI: 10.1016/j.ajem.2019.05.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 11/16/2022] Open
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13
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Villablanca PA, Vlismas PP, Aleksandrovich T, Omondi A, Gupta T, Briceno DF, Garcia MJ, Wiley J. Case report and systematic review of pulmonary embolism mimicking ST-elevation myocardial infarction. Vascular 2018; 27:90-97. [DOI: 10.1177/1708538118791917] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background To study trends in the clinical presentation, electrocardiograms, and diagnostic imaging in patients with pulmonary embolism presenting as ST segment elevation. Methods We performed a systematic literature search for all reported cases of pulmonary embolism mimicking ST-elevation myocardial infarction. Pre-specified data such as clinical presentation, electrocardiogram changes, transthoracic echocardiographic findings, cardiac biomarkers, diagnostic imaging, therapy, and outcomes were collected. Results We identified a total of 34 case reports. There were 23 males. Mean age of the population was 56.5 ± 15.5 years. Patients presented with dyspnea (76.4%), chest pain (63.6%), and tachycardia (71.4%). All patients presented with ST-elevations, with the most common location being in the anterior-septal distribution, lead V3 (74%), V2 (71%), V1 (62%) and V4 (47%). ST-segment elevations in the inferior distribution were present in lead II (12%), III (18%), and aVF (21%). Presentation was least likely in the lateral distribution. Troponin was elevated in 78.9% of cases. Right ventricular strain was the most common echocardiographic finding. Over 80% of patients had findings consistent with elevated right ventricular pressure, with 50% reported RV dilatation and 20% RV hypokinesis. The most commonly used imaging modality was contrast-enhanced pulmonary angiography. There was a greater incidence of bilateral compared to unilateral pulmonary emboli (72.4% vs. 10%). About 65% patients received anticoagulation and 36.3% were treated with thrombolytics. Forty-six percent of patients required intensive care and 18.7% intubation. Overall mortality was 25.8%. Conclusions A review of the literature reveals that in patients presenting with pulmonary embolism, electrocardiogram findings of ST-segment elevations will occur predominantly in the anterior-septal distribution.
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Affiliation(s)
- Pedro A Villablanca
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Peter P Vlismas
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Tatsiana Aleksandrovich
- Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Arthur Omondi
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Tanush Gupta
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - David F Briceno
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mario J Garcia
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jose Wiley
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
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Mistry A, Natarajan N, Hussain S, Vali Z. Unusual presentation of acute pulmonary embolus presenting with inferior ST elevation. BMJ Case Rep 2018; 2018:bcr-2018-226063. [PMID: 30065059 DOI: 10.1136/bcr-2018-226063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Amar Mistry
- Cardiovascular Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Nalin Natarajan
- Cardiovascular Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Shahana Hussain
- Cardiovascular Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Zakariyya Vali
- Cardiovascular Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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15
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Morrone D, Morrone V. Acute Pulmonary Embolism: Focus on the Clinical Picture. Korean Circ J 2018; 48:365-381. [PMID: 29737640 PMCID: PMC5940642 DOI: 10.4070/kcj.2017.0314] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 03/27/2018] [Accepted: 04/11/2018] [Indexed: 12/29/2022] Open
Abstract
Acute pulmonary embolism (APE) is characterized by numerous clinical manifestations which are the result of a complex interplay between different organs; the symptoms are therefore various and part of a complex clinical picture. For this reason, it may not be easy to make an immediate diagnosis. This is a comprehensive review of the literature on all the various clinical pictures in order to help physicians to promptly recognize this clinical condition, remembering that our leading role as cardiologists depends on and is influenced by our knowledge and working methods.
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Affiliation(s)
- Doralisa Morrone
- Department of Surgery, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy.
| | - Vincenzo Morrone
- Department of Cardiology, SS. Annunziata Hospital, Taranto, Italy
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Unique ECG Findings in Acute Pulmonary Embolism: STE with Reciprocal Changes and Pathologic Q Wave. Case Rep Crit Care 2018; 2018:7865894. [PMID: 29850272 PMCID: PMC5903203 DOI: 10.1155/2018/7865894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/19/2018] [Indexed: 01/19/2023] Open
Abstract
A 68-year-old male presented to the emergency department with retrosternal chest pain, presyncope, and then a pulseless electrical activity cardiac arrest. An ECG prior to his arrest revealed ST elevations in leads V1–V3, Q waves in lead V2, and reciprocal ST depressions in the lateral and inferior leads. He received thrombolytic therapy for a presumptive diagnosis of ST elevation myocardial infarction. Return of spontaneous circulation was achieved and he underwent a coronary angiogram. No critical disease was found and his left ventriculogram showed normal contraction. His ongoing metabolic acidosis and dependence on an intra-aortic balloon pump, despite adequate cardiac output, prompted a CT pulmonary angiogram which showed multiple segmental filling defects. He was treated for a pulmonary embolism and was discharged 5 days later. Acute pulmonary embolism (APE) has variable clinical presentations. To our knowledge, this is the first case report of an APE presenting with these ECG findings suggestive of myocardial ischemia. In this case report, we discuss the underlying physiological mechanisms responsible and offer management suggestions for emergency department and critical care physicians to better expedite the treatment of APE mimicking acute coronary syndrome on ECG.
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Alkhalil M, Cahill TJ, Boardman H, Choudhury RP. Concomitant pulmonary embolism and myocardial infarction due to paradoxical embolism across a patent foramen ovale: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2017; 1:ytx010. [PMID: 31020069 PMCID: PMC6177106 DOI: 10.1093/ehjcr/ytx010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/29/2017] [Indexed: 01/21/2023]
Abstract
Concomitant acute myocardial infarction (MI) and pulmonary embolism (PE) is exceedingly rare. However, establishing the diagnosis early is essential, since delay in treating the patient may lead to a potential fatal outcome. Right ventricular (RV) infarction in the setting of inferior ST-segment elevation MI (STEMI), coupled with acute massive PE confers particular risk due acute RV failure and low cardiac output, threatening survival. We report a rare case of concomitant PE and inferior STEMI in a 43-year-old woman with a history of acute chest pain. She was haemodynamically compromised, with Type I respiratory failure but lack of signs of heart failure. Early recognition of dual pathologies prompted administration of thrombolytic therapy and simultaneous right coronary artery thrombectomy to treat PE and STEMI. Prompt clinical diagnosis and delivery of targeted therapies adapted for the specific clinical presentation may have averted fatal outcome.
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Affiliation(s)
- Mohammad Alkhalil
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK.,Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK
| | - Thomas J Cahill
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK
| | - Henry Boardman
- Department of Cardiology, Oxford Heart Centre, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK
| | - Robin P Choudhury
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK.,Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK
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18
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Right-sided electrocardiogram usage in acute pulmonary embolism. Am J Emerg Med 2016; 34:1437-41. [PMID: 27133923 DOI: 10.1016/j.ajem.2016.04.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/05/2016] [Accepted: 04/13/2016] [Indexed: 11/24/2022] Open
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