Using Cardiac Magnetic Resonance Imaging to Evaluate Patients with Chest Pain in the Emergency Department

Case report: acute myocarditis in two patients with coronary artery disease presenting with chest pain-thinking outside the box

Background

In a subset of patients, acute myocarditis (AM) may mimic acute myocardial infarction, with a similar clinical presentation characterized by chest pain, electrocardiogram (ECG) changes consistent with acute coronary syndromes (ACS), and serum markers increment.

Case summary

We present two cases of infarct-like myocarditis in patients with known coronary artery disease (CAD), in which the discrepancy between transthoracic echocardiogram findings, ECG, and angiography prompted us to look beyond the simplest diagnosis. In these cases, making a prompt and correct diagnosis is pivotal to address adequate therapy and establish a correct prognosis.

Discussion

The right diagnosis can avoid unnecessary coronary revascularizations and subsequent antiplatelet therapy that may be associated with an increased haemorrhagic risk. Moreover, it allows setting up guideline-directed therapy for myocarditis, proper follow-up, as well as recommending abstention from physical activity.

Cardiac Magnetic Resonance Imaging (CMRI) Applications in Patients with Chest Pain in the Emergency Department: A Narrative Review

CMRI is the exclusive imaging technique capable of identifying myocardial edema, endomyocardial fibrosis, pericarditis accompanied by pericardial effusions, and apical thrombi within either the left or right ventricle. In this work, we examine the research literature on the use of CMRI in the diagnosis of chest discomfort, employing randomized controlled trials (RCTs) to evaluate its effectiveness. The research outlines the disorders of the chest and the machine learning approaches for detecting them. In conclusion, the study ends with an examination of a fundamental illustration of CMRI analysis. To find a comprehensive review, the Scopus scientific resource is analyzed. The issue, based on the findings, is to distinguish ischemia from non-ischemic cardiac causes of chest pain in individuals presenting with sudden chest pain or discomfort upon arrival at the emergency department (ED). Due to the failure of conventional methods in accurately diagnosing acute cardiac ischemia, individuals are still being inappropriately discharged from the ED, resulting in a heightened death rate.

Three-Dimensional Echocardiography and Coagulation Function Detection in the Prognosis Evaluation of Patients with Acute Myocardial Infarction

This research was aimed at discussing the application value of coagulation function detection and three-dimensional echocardiography in the prognosis evaluation of acute myocardial infarction (AMI) patients. 72 patients with AMI were divided into the recovered group (good recovery) and unrecovered group (poor recovery) according to the results of postoperative ultrasonography. The left ventricular parameters of the patients were detected by three-dimensional ultrasound, and the coagulation function was also detected. The results showed that 3 months after surgery, the regional end-systolic volume (rESV) and regional end-diastolic volume (rEDV) of the left ventricle in the patients were smaller than the measured values 1 week after surgery. The left ventricular regional ejection fraction (rEF) was greater than the value measured 1 week after surgery, and all the differences were statistically significant (P < 0.05). For the end-systolic volume (ESV), end-diastolic volume (EDV), and ejection fraction (EF) (%), the two-dimensional ultrasound results were significantly lower than the three-dimensional ultrasound results, and there were significant differences (P < 0.05). Tmsvle6-Dif% of the recovered patients was 14.99 ± 9.88 and 14.37 ± 9.78 3 months and 6 months after surgery, respectively. These were smaller than 30.91 ± 18.63 and 33.51 ± 17.96 of the unrecovered patients; the differences were of statistical significance (P < 0.05). Tmsvl6-SD% of recovered patients was 3.69 ± 2.47 and 3.61 ± 1.83 3 months and 6 months after surgery, respectively, which were also smaller than 7.38 ± 4.06 and 7.96 ± 2.82 of unrecovered patients, showing statistically significant difference (P < 0.05). The postoperative Tmsvle6-Dif% and Tmsvl6-SD% of the recovered group were lower than those of the unrecovered patients, with the statistically significant differences (P < 0.05). The level of coagulation factors in the recovered group was also significantly lower than that in the unrecovered group with the difference statistically significant (P < 0.05). The results suggested that three-dimensional echocardiography played an important role in the evaluation of cardiac conditions in AMI patients. The level of coagulation factors varied with the AMI condition of patients, and there was an obvious relationship between them, which could provide a reference value for the prognosis evaluation of patients.