1. EPIGASTRIC PAIN RESULTING IN ACUTE MYOCARDIAL INFARCTION IN A YOUNG PATIENT AND THE IMPLICATIONS OF COCAINE USE - A CASE REPORT.
- Author
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Petrus, Cristiana, Pîrcălabu, Maria, and Nenu, Iuliana
- Subjects
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MYOCARDIAL infarction , *COCAINE , *MYOCARDIAL ischemia , *ABDOMINAL pain , *CONFERENCES & conventions , *ELECTROCARDIOGRAPHY , *ST elevation myocardial infarction , *BIOMARKERS - Abstract
Introduction: ST-segment elevation myocardial infarction (STEMI) frequently manifests as an acute presentation in the Emergency Department. While chest pain is a hallmark symptom along with dyspnea, arm and jaw pain described as dull, heavy, tight or crushing, a considerable number of patients may not exhibit this symptom upon presentation. Epigastric pain is an unusual but potentially critical presenting symptom of STEMI and it poses diagnostic challenges and underscores the importance of considering a broader range of symptoms in the evaluation of acute myocardial infarction(AMI). Case Report: 33-year-old male patient, presented to the Gastroenterology Emergency Department due to epigastric pain. He has a pertinent family history, with his father succumbing to acute myocardial infarction at a young age. Paraclinical investigations revealed elevated levels of lactate dehydrogenase(434.00 U/L) and C-reactive protein(8.38 mg/L), markers for myocardial damage. However, there were no modifications in creatine kinase-MB levels. An electrocardiogram was promptly performed, revealing ST-segment elevation in derivations V1-V5 which primarily reflect myocardial ischemia involving the septal and anterior walls of the left ventricle. During the anamnesis, it was discovered that the patient had a history of regular cocaine use. This information adds a crucial dimension to the case, as cocaine consumption is associated with an increased risk of acute myocardial infarction owing its vasoconstrictive and pro-thrombotic effects. The patient was transferred to another hospital where they underwent angiography, angioplasty, and echocardiography. During the angiography, a lesion in the left dominant coronary artery was discovered together with significant subocclusive stenosis. PCI IVA was successfully performed during the procedure and the patient's condition improved, aided also by the young age. Discussions : Patients presenting with epigastric pain benefit from an electrocardiogram(EKG), as a significant percentage of both men and women with acute myocardial infarction report in clinics similar symptoms. Given the prevalence of epigastric pain in myocardial infarction cases, conducting an EKG evaluation is crucial to assess for possible cardiac etiologies and ensure a comprehensive differential diagnosis. Conclusions: This case underscores the importance of prompt diagnosis of acute myocardial infarction, particularly when presented with atypical symptoms such as epigastric pain. The recognition of cardiac involvement in patients with non-specific complaints like epigastric pain is crucial for timely intervention and improved outcomes. Additionally, the importance of cocaine use as a contributing factor to the risk of myocardial infarction cannot be overstated. Healthcare providers should remain vigilant for cardiac events in individuals with a history of cocaine use. [ABSTRACT FROM AUTHOR]
- Published
- 2024