The ECG was correct. The angiogram was not.

In this study, approximately 10% of Transient STEMI had no culprit found:Early or late intervention in patients with transient ST ‐segment elevation acute coronary syndrome: Subgroup analysis of the ELISA‐3 trialOne must use all available data, including the ECG, to determine what happened.Final Diagnosis?If the troponin remained under the 99% reference, then it would be unstable angina.  If it rose above that level before falling, it would be acute myocardial injury due to ischemia, which is, by definition, acute MI.  If that is a result of plaque rupture, then it is a type I MI.  The clinical presentation would be one of either unstable angina or type I MI, even if no culprit was found on angiography.See this post for another case of OMI with a negative angiogram, and here are more references:Inferior hyperacute T-waves and ST elevation. Angiogram is normal. What happened?Bibliography, with edited abstractsArticle 1There were 821 cath lab activations and 86% were treated by mechanical revascularization. In 76 patients (8.5%), no coronary artery stenosis was documented. Observations documented angiographically included coronary spasms (6.6%) and muscle bridges (5.3%). During a mean follow-up of 11.2 ±6.4 months, one patient developed an acute myocardial infarction requiring coronary intervention. All other patients were free of any cardiac event.Article 2, full textOf 898 patients who had cath lab activations for primary PCI, normal corona...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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We present the case of a male diagnosed with a giant hepatic artery aneurysm, which first presented with pain and hemorrhage due to a partial rupture of the aneurysm. After discarding treatment with a stent or surgery due to the wide extension, we chose to embolize the hepatic artery with coils. However, the progress was unfavorable after the procedure, with the appearance of liver failure that was resolved by an urgent liver transplantation. Giant hepatic artery pseudoaneurysms are an infrequent entity and their management is a great challenge. The diagnosis is usually delayed due to non-specific clinical signs and the li...
Source: Revista Espanola de Enfermedades Digestivas - Category: Gastroenterology Tags: Rev Esp Enferm Dig Source Type: research
Authors: Rovira Argelagués M, Calvet Medina EJ, Pierres Mir M, Navarro Sanahuja J Abstract Radiological images of a patient consulting the emergency room for pain in the right hypochondrium and hypercalcified images in the right-medial area of ​​the upper hemiabdomen, which correspond to the floating gallbladder. PMID: 31526007 [PubMed - as supplied by publisher]
Source: Revista Espanola de Enfermedades Digestivas - Category: Gastroenterology Tags: Rev Esp Enferm Dig Source Type: research
In conclusion, even if it is still totally hypothetical, our point of view may have clinical consequences, especially when deciding to perform a liver biopsy in patients with a higher liver stiffness and suspending the anticoagulation in patients with PVT and no detectable prothrombotic factors. PMID: 31528244 [PubMed]
Source: World Journal of Hepatology - Category: Gastroenterology Tags: World J Hepatol Source Type: research
Authors: Nagamura N, Higuchi H Abstract A middle-aged man presented with a fever, arthralgia, gastrointestinal symptoms, headache, and rash. After two weeks, the patient suddenly complained of severe abdominal pain, and computed tomography revealed aneurysms in the hepatic and splenic arteries, which increased in size progressively. Given the elevated levels of inflammatory markers and orchitis, polyarteritis nodosa (PN) was initially suspected. Catheter embolization for the ruptured hepatic aneurysm and splenectomy for the large splenic ones were performed, and the pathological finding was consistent with segmenta...
Source: Internal Medicine - Category: Internal Medicine Tags: Intern Med Source Type: research
A 41-year-old female patient from Afghanistan was referred to our hospital because of multiple cysts in both liver and kidneys accompanied by recurrent left flank pain and hematuria. Despite inconclusive family history, the patient was suspected of suffering from autosomal dominant polycystic kidney disease (ADPKD) on the basis of a medical history of adult-onset polycystic kidneys. Abdominal ultrasound revealed multicystic liver and kidneys with many typical cysts, but also an atypical, echogenic, and partially calcified lesion in liver segment VI as well as an atypical, septated, and partially calcified lesion in the spl...
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: Make Your Diagnosis Source Type: research
A 44-year-old woman developed acute anuric renal failure in the context of septic shock after hysteroscopy and intrauterine device placement for abnormal uterine bleeding. Aminoglycoside and nonsteroidal anti-inflammatory drug use were likely contributing factors. In the past, she had had a deep venous thrombosis episode on oral contraception that led to a diagnosis of Factor V Leiden heterozygosity. Computed tomography with contrast of the abdomen and pelvis showed abnormal enhancement of the renal medulla, and the renal cortex did not take on contrast (Figure  1).
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: Nephrology Image Source Type: research
Early Life Trauma (ELT), trauma before the age of 18, often has a negative psychological impact, even into adulthood. ELT has been linked to a variety of psychopathologies in adulthood including anxiety, depression, substance abuse, and PTSD (e.g., Bremner...
Source: SafetyLit - Category: International Medicine & Public Health Tags: Age: Adolescents Source Type: news
This study utilized qualitative methodology to provide a rich description and a deeper understanding of the professional experiences and practices of twelve school counselors who work with adolescent students who self-harm. Four themes included: suicidal o...
Source: SafetyLit - Category: International Medicine & Public Health Tags: Age: Adolescents Source Type: news
Adolescence is a complex transition from childhood to adulthood: the onset of puberty sees substantial biological growth and development, but the biochemical and psychological changes are more challenging and less visible. These changes can overwhelm and...
Source: SafetyLit - Category: International Medicine & Public Health Tags: Age: Adolescents Source Type: news
Authors: Mohd Sahardi NFN, Makpol S Abstract Currently, the age of the population is increasing as a result of increased life expectancy. Ageing is defined as the progressive loss of physiological integrity, which can be characterized by functional impairment and high vulnerability to various types of diseases, such as diabetes, hypertension, Alzheimer's disease (AD), Parkinson's disease (PD), and atherosclerosis. Numerous studies have reported that the presence of oxidative stress and inflammation contributes to the development of these diseases. In general, oxidative stress could induce proinflammatory cytokines ...
Source: Evidence-based Complementary and Alternative Medicine - Category: Complementary Medicine Tags: Evid Based Complement Alternat Med Source Type: research
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