Acute Myocardial Infarction Caused by Coronary Spasm and Dissection Treated with Medical Therapy.

We report the case of a 33-year-old woman with no history of coronary risk factors or chest pain who experienced intermittent chest pain at rest for several minutes from 2 PM. At 8 AM the next day, chest pain recurred and persisted for about 1 hour. She was transported to our hospital by ambulance, where electrocardiogram showed ST-elevation in the precordial leads, and blood tests showed elevation of cardiac markers. She was diagnosed with ST-elevation myocardial infarction. Because she was a young woman without any risk factors, coronary spastic angina was suspected. Coronary angiography without intracoronary nitrate administration revealed diffuse 75% stenosis in the proximal right coronary artery (RCA) and diffuse 90% stenosis in the left anterior descending artery (LAD). A coronary spasm provocation test elicited chest pain; coronary angiography showed 99% diffuse stenosis of LAD; and electrocardiogram showed precordial ST-segment elevation. Although intracoronary nitroglycerin injection attenuated the coronary spasm in the RCA and proximal LAD, 90% stenosis and coronary dissection were observed in the midportion of the LAD. When the imaging test that was carried out before the provocation test was reexamined, the dissection was recognized, and there was no clear dissection progress after the test. Intravascular ultrasound showed dissection of the LAD, as did angiography. We treated the patient using medical therapy instead of percutaneous coronary intervention.The patie...
Source: International Heart Journal - Category: Cardiology Tags: Int Heart J Source Type: research

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Conclusions Patient and system factors both significantly influenced QI times in this cohort with unstable angina/NSTEMI. These results illustrate both the complexity of diagnosing patients with NSTEMI and the competing effects of clinical and system factors on patient flow through the ED.
Source: Journal of Patient Safety - Category: Health Management Tags: Original Articles Source Type: research
A HEART attack doesn't always involve a breathtaking jibe in the chest and, even if it does, some people may brush past the pain as something insignificant. Take notice of your bodily sensations; it could indicate a heart attack.
Source: Daily Express - Health - Category: Consumer Health News Source Type: news
CONCLUSION: No associations were found between patient-physician language concordance and outcomes or physician adherence to clinical recommendations for ED patients with chest pain. Accessible and effective interpretation services, combined with a decision support tool with standard clinical recommendations, may have contributed to equitable care. PMID: 32056327 [PubMed - as supplied by publisher]
Source: Accident and Emergency Nursing - Category: Emergency Medicine Authors: Tags: Acad Emerg Med Source Type: research
ConclusionsDespite a decline in utilization of most healthcare services throughout the investigated decade, healthcare expenditure has not changed. Further evaluation of the cost-effectiveness of long-term resource allocation following AMI is warranted. Nevertheless, we believe more intense ambulatory follow-up focusing on secondary prevention and early detection, as well as high-quality outpatient chest pain unit are warranted.
Source: Israel Journal of Health Policy Research - Category: International Medicine & Public Health Source Type: research
Conclusions: The initial diagnosis and management of STEMI need to be improved in medical undergraduate courses and inserted into the reality of the hierarchical network structure of the Brazilian Unified Health System (SUS).Resumo Fundamento: Houve importante redu ção da morbimortalidade do infarto agudo do miocárdio com supradesnível do segmento ST (IAMCSST) com o desenvolvimento das terapias de reperfusão. Para garantir este benefício é importante o diagnóstico precoce e manejo inicial correto. No Brasil, recém-formados do curso de medicina são re spo...
Source: Arquivos Brasileiros de Cardiologia - Category: Cardiology Source Type: research
Conclusions: The initial diagnosis and management of STEMI need to be improved in medical undergraduate courses and inserted into the reality of the hierarchical network structure of the Brazilian Unified Health System (SUS).Resumo Fundamento: Houve importante redu ção da morbimortalidade do infarto agudo do miocárdio com supradesnível do segmento ST (IAMCSST) com o desenvolvimento das terapias de reperfusão. Para garantir este benefício é importante o diagnóstico precoce e manejo inicial correto. No Brasil, recém-formados do curso de medicina são re spo...
Source: Arquivos Brasileiros de Cardiologia - Category: Cardiology Source Type: research
AbstractCurrent guidelines recommend the use of exercise stress echocardiography (ESE) in patients with unexplained dyspnoea. SE was recently reshaped with the ABCDE protocol: A for asynergy, B for B-lines (4-site simplified scan), C for contractile reserve based on force, D for Doppler-based coronary flow velocity reserve (CFVR) in left anterior descending coronary artery; and E for EKG-based heart rate reserve (HRR, defined as peak/rest HR  
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research
If you have a CT heart scan score (also called coronary calcium score), what effect do statin cholesterol drugs have on stopping or slowing the increase in score? (Increasing scores pose increasing risk for heart attack and other cardiac events.) NONE. If you do nothing at all, the score increases by 25% per year, on average. If you take a statin drug, aspirin, and follow a low-fat diet, what my colleagues call “optimal medical therapy,” the score increases . . . 25% per year—no difference. Yet this is the “solution” that conventional doctors push on their patients, a “treatment” t...
Source: Wheat Belly Blog - Category: Cardiology Authors: Tags: Open cholesterol coronary calcium ct scan do statin drugs reduce heart scan scores reduce coronary calcium reverse coronary calcium reverse heart disease undoctored wheat belly Source Type: blogs
"Nearly 20 years ago, at age 50, I was walking out of the cafeteria at work with my morning coffee, when I felt a sudden onset of pain in the center of my chest. ... I assumed it was heartburn and ...
Source: AARP.org News - Category: American Health Source Type: news
Publication date: Available online 5 February 2020Source: American Heart JournalAuthor(s): Jordan Gales, Richard A. Krasuski, Jordan D. AwerbachBackgroundData regarding emergency department (ED) assessment of acute chest pain (CP) and incidence of myocardial infarction (MI) among adult congenital heart disease (ACHD) patients, relative to the non-congenital population, is lacking.ObjectivesTo describe MI risk in ACHD patients presenting to the ED with chest pain and to compare clinical characteristics, diagnostic testing patterns, and outcomes to controls.MethodsWe retrospectively identified a cohort of ACHD patients prese...
Source: American Heart Journal - Category: Cardiology Source Type: research
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