A Case of Acute Non-ST Elevation Myocardial Infarction Later Revealed by Contrast-Enhanced Computed Tomography.

Content Provider	Europe PMC
Author	Miyamoto, Kazuyuki Kaki, Yuki Katsuki, Shino Maeda, Atsuo Nakamura, Motoyasu Suzuki, Keisuke Yagi, Masaharu Sasaki, Jun Dohi, Kenji Hayashi, Munetaka
Copyright Year	2022
Abstract	Patient: Female, 82-year-oldFinal Diagnosis: Non-ST elevated myocardial infarctionSymptoms: Back pain • epigastric painMedication: —Clinical Procedure: —Specialty: CardiologyObjective:Unusual clinical course Background:Acute coronary syndrome is life-threatening. The diagnosis can be confirmed by electrocardiography (ECG) and serum cardiac biomarkers. Early diagnosis and treatment of non-ST segment elevation myocardial infarction (NSTEMI) is important because delayed treatment is associated with poor prognosis, especially in older adults.Case Report:An 82-year-old woman presented to the Emergency Department (ED) with epigastric and back pain. Despite the symptoms, the electrocardiogram revealed no abnormality, and the high-sensitivity cardiac troponin (Hs-cTn) value was below the detection limit. Chest contrast-enhanced computed tomography (CT) performed to exclude fatal diseases such as aortic dissection revealed no obvious abnormalities. The patient’s symptoms improved and she was discharged. On the following day, the radiologist reviewed the CT and noted reduced cardiac uptake of contrast medium, and so suspected a subendocardial infarction. The patient was immediately recalled to the ED. She had no symptoms, but her Hs-cTn level was markedly elevated and asynergy was found on echocardiography. Emergency coronary angiography revealed complete obstruction of the left anterior descending coronary artery.Conclusions:Similar to patients with acute ST segment elevation myocardial infarction, those with unstable angina or NSTEMI should be treated early. Delayed diagnosis and treatment of acute coronary syndrome is associated with poor prognosis, especially in older adults. Therefore, in patients presenting to the ED with chest pain, careful attention should be paid to myocardial staining in addition to the aorta, pulmonary arteries, and abdominal organs, when performing contrast-enhanced CT.
Volume Number	23
PubMed Central reference number	PMC9335400
PubMed reference number	35877597
Journal	The American Journal of Case Reports [Am J Case Rep]
e-ISSN	19415923
DOI	10.12659/AJCR.936891
Language	English
Publisher	International Scientific Literature, Inc.
Publisher Date	2022-07-25
Access Restriction	Open
Rights License	This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) © Am J Case Rep, 2022
Subject Keyword	Contrast Media Delayed Diagnosis Multidetector Computed Tomography Non-ST Elevated Myocardial Infarction
Content Type	Text
Resource Type	Article
Subject	Medicine