BACKGROUND Typically,right coronary artery(RCA)occlusion causes ST-segment elevation in inferior leads.However,it is rarely observed that RCA occlusion causes STsegment elevation only in precordial leads.In general,an...BACKGROUND Typically,right coronary artery(RCA)occlusion causes ST-segment elevation in inferior leads.However,it is rarely observed that RCA occlusion causes STsegment elevation only in precordial leads.In general,an electrocardiogram is considered to be the most important method for determining the infarct-related artery,and recognizing this is helpful for timely discrimination of the culprit artery for reperfusion therapy.In this case,an elderly woman presented with chest pain showing dynamic changes in precordial ST-segment elevation with RCA occlusion.CASE SUMMARY A 96-year-old woman presented with acute chest pain showing precordial STsegment elevation with dynamic changes.Myocardial injury markers became positive.Coronary angiography indicated acute total occlusion of the proximal nondominant RCA,mild atherosclerosis of left anterior descending artery and 75%stenosis in the left circumflex coronary artery.Percutaneous coronary intervention was conducted for the RCA.Repeated manual thrombus aspiration was performed,and fresh thrombus was aspirated.A 2 mm×15 mm balloon was used to dilate the RCA with an acceptable angiographic result.The patient’s chest pain was relieved immediately.A postprocedural electrocardiogram showed alleviation of precordial ST-segment elevation.The diagnosis of acute isolated right ventricular infarction caused by proximal nondominant RCA occlusion was confirmed.Echocardiography indicated normal motion of the left ventricular anterior wall and interventricular septum(ejection fraction of 54%),and the right ventricle was slightly dilated.The patient was asymptomatic during the 9-mo follow-up period.CONCLUSION Cardiologists should be conscious that precordial ST-segment elevation may be caused by occlusion of the nondominant RCA.展开更多
Symptomatic hepato-diaphragmatic interposition of a bowel loop or Chilaiditi's syndrome is a peculiar anatomical condition most often found by chance. Its described symptoms range from intermittent, mild abdominal...Symptomatic hepato-diaphragmatic interposition of a bowel loop or Chilaiditi's syndrome is a peculiar anatomical condition most often found by chance. Its described symptoms range from intermittent, mild abdominal pain and dyspepsia to acute intestinal obstruction. We report a case of hepato-diaphragmatic migration of the hepatic flexure of the colon associated to an unusual, heretofore unreported, angina-like pain exclusively evoked by the left lateral decubitus. To maximize the chance of observing anatomical changes in different postures, computed tomography of the chest and abdomen was performed after air insufflation into the colon. While frank herniation into the chest was excluded, the scan showed that the hepatic flexure-with the interposition of the diaphragm-came in contact with the right side of the heart in the left lateral, but not in the supine, decubitus. This finding was reproduced by echocardiography which also showed virtually unaltered hemodynamics after the change of posture. ECG, left and right ventricular global and regional function as well as cardiac injury markers also remained unchanged during the maneuver, indicating that the pain evoked by the latter was unlikely due to myocardial ischemia. This case suggests that Chilaiditi's syndrome should be included among the possible, although rare,causes of unexplained angina-like symptoms.展开更多
BACKGROUND Wellen’s syndrome is a form of acute coronary syndrome associated with proximal left anterior descending artery(LAD)stenosis and characteristic electro-cardiograph(ECG)patterns in pain free state.The abnor...BACKGROUND Wellen’s syndrome is a form of acute coronary syndrome associated with proximal left anterior descending artery(LAD)stenosis and characteristic electro-cardiograph(ECG)patterns in pain free state.The abnormal ECG pattern is classified into type A(biphasic T waves)and type B(deeply inverted T waves),based on the T wave pattern seen in the pericodial chest leads.CASE SUMMARY We present the case of a 37-year-old male with history of type 1 diabetes mellitus(T1DM),gastroparesis,mild peripheral artery disease and right toe cellulitis on IV antibiotics who presented to the emergency department with nausea,vomiting and abdominal pain for 3 d and as a result couldn’t take his insulin.Noted to have fasting blood sugar 392 mg/dL.Admitted for diabetic gastroparesis.During the hospital course,the patient was asymptomatic and denied any chest pain.On admission,No ECG and troponin draws were performed.On day 2,the patient became hypoxic with oxygen saturation 80%on room air,intermittent mild right-sided chest pain which he attributed to vomiting from his gastroparesis.Initial ECG done was significant for Biphasic T wave changes in leads V2 and V3 and elevated high sensitivity troponin.Patient was transitioned to cardiac intensive care unit and cardiac catheterization performed with result significant for extensive coronary artery disease.CONCLUSION This case highlights an exceptional manifestation of Wellen's syndrome,wherein the right coronary artery and circumflex artery display a remarkable 100%constriction,alongside a proximal LAD stenosis of 90%-95%.Notably,this occurrence transpired in a patient grappling with extensive complications arising from T1DM.Moreover,it underscores the utmost significance of promptly recognizing the presence of Wellen's syndrome and swiftly initiating appropriate medical intervention.展开更多
基金Natural Science Basic Research Program of Shaanxi Province,No.2020JQ-939.
文摘BACKGROUND Typically,right coronary artery(RCA)occlusion causes ST-segment elevation in inferior leads.However,it is rarely observed that RCA occlusion causes STsegment elevation only in precordial leads.In general,an electrocardiogram is considered to be the most important method for determining the infarct-related artery,and recognizing this is helpful for timely discrimination of the culprit artery for reperfusion therapy.In this case,an elderly woman presented with chest pain showing dynamic changes in precordial ST-segment elevation with RCA occlusion.CASE SUMMARY A 96-year-old woman presented with acute chest pain showing precordial STsegment elevation with dynamic changes.Myocardial injury markers became positive.Coronary angiography indicated acute total occlusion of the proximal nondominant RCA,mild atherosclerosis of left anterior descending artery and 75%stenosis in the left circumflex coronary artery.Percutaneous coronary intervention was conducted for the RCA.Repeated manual thrombus aspiration was performed,and fresh thrombus was aspirated.A 2 mm×15 mm balloon was used to dilate the RCA with an acceptable angiographic result.The patient’s chest pain was relieved immediately.A postprocedural electrocardiogram showed alleviation of precordial ST-segment elevation.The diagnosis of acute isolated right ventricular infarction caused by proximal nondominant RCA occlusion was confirmed.Echocardiography indicated normal motion of the left ventricular anterior wall and interventricular septum(ejection fraction of 54%),and the right ventricle was slightly dilated.The patient was asymptomatic during the 9-mo follow-up period.CONCLUSION Cardiologists should be conscious that precordial ST-segment elevation may be caused by occlusion of the nondominant RCA.
文摘Symptomatic hepato-diaphragmatic interposition of a bowel loop or Chilaiditi's syndrome is a peculiar anatomical condition most often found by chance. Its described symptoms range from intermittent, mild abdominal pain and dyspepsia to acute intestinal obstruction. We report a case of hepato-diaphragmatic migration of the hepatic flexure of the colon associated to an unusual, heretofore unreported, angina-like pain exclusively evoked by the left lateral decubitus. To maximize the chance of observing anatomical changes in different postures, computed tomography of the chest and abdomen was performed after air insufflation into the colon. While frank herniation into the chest was excluded, the scan showed that the hepatic flexure-with the interposition of the diaphragm-came in contact with the right side of the heart in the left lateral, but not in the supine, decubitus. This finding was reproduced by echocardiography which also showed virtually unaltered hemodynamics after the change of posture. ECG, left and right ventricular global and regional function as well as cardiac injury markers also remained unchanged during the maneuver, indicating that the pain evoked by the latter was unlikely due to myocardial ischemia. This case suggests that Chilaiditi's syndrome should be included among the possible, although rare,causes of unexplained angina-like symptoms.
文摘BACKGROUND Wellen’s syndrome is a form of acute coronary syndrome associated with proximal left anterior descending artery(LAD)stenosis and characteristic electro-cardiograph(ECG)patterns in pain free state.The abnormal ECG pattern is classified into type A(biphasic T waves)and type B(deeply inverted T waves),based on the T wave pattern seen in the pericodial chest leads.CASE SUMMARY We present the case of a 37-year-old male with history of type 1 diabetes mellitus(T1DM),gastroparesis,mild peripheral artery disease and right toe cellulitis on IV antibiotics who presented to the emergency department with nausea,vomiting and abdominal pain for 3 d and as a result couldn’t take his insulin.Noted to have fasting blood sugar 392 mg/dL.Admitted for diabetic gastroparesis.During the hospital course,the patient was asymptomatic and denied any chest pain.On admission,No ECG and troponin draws were performed.On day 2,the patient became hypoxic with oxygen saturation 80%on room air,intermittent mild right-sided chest pain which he attributed to vomiting from his gastroparesis.Initial ECG done was significant for Biphasic T wave changes in leads V2 and V3 and elevated high sensitivity troponin.Patient was transitioned to cardiac intensive care unit and cardiac catheterization performed with result significant for extensive coronary artery disease.CONCLUSION This case highlights an exceptional manifestation of Wellen's syndrome,wherein the right coronary artery and circumflex artery display a remarkable 100%constriction,alongside a proximal LAD stenosis of 90%-95%.Notably,this occurrence transpired in a patient grappling with extensive complications arising from T1DM.Moreover,it underscores the utmost significance of promptly recognizing the presence of Wellen's syndrome and swiftly initiating appropriate medical intervention.
