Background: Biomarkers play an important role in the early diagnosis, risk stratification and management of patients with the acute coronary syndrome. Objective: The objective of this study was to evaluate the clinical reliability of heart-type fatty acid-binding protein (h-FABP) in identifying patients with the acute coronary syndrome in the early hours of chest pain. Methods: Creatine kinase (CK-MB) (in laboratory), troponin T (in laboratory) and h-FABP (with point-of-care test CardioDetect ) were performed on 791 patients who presented with chest pain with duration since onset ranging from 20 minutes to 12 hours. Results: Data of the 791 patients were analysed. h-FABP had a higher sensitivity of 75.76% and a specificity of 96.97% compared with 58.59% and 98.84% for troponin T and 68.69% and 97.54% for CK-MB respectively (in the first 6 hours). Conclusion: h-FABP was found to be a better biomarker of cardiac necrosis in the early hours in the diagnosis of nonconclusive ECG in patients with acute myocardial infarction.
SUMMARYSpontaneous carotid artery dissection in pregnancy has not been reported before. We present a case of a 31-year-old Caucasian woman who was 11 weeks pregnant and presented with neck pain, headache, vomiting and left side Horner's syndrome. Subsequent investigations with MR angiography confirmed spontaneous left internal carotid artery dissection.
BACKGROUND
Asymptomatic spontaneous coronary artery spasm is rare and there are no case reports in literature presenting with acute ST elevation on routine ECG. We present the case of a 68-year-old Caucasian man who presented to a primary care physician for a routine ECG as part of hypertension follow-up. ECG revealed ST elevation in inferior leads II, III and aVF with reciprocal ST depression in leads I, aVL and also ST depression in anterior leads V1, V2 and V3 suggesting ongoing inferoposterior ST elevation myocardial infarction. The patient was completely well, stable and asymptomatic and he was rushed immediately to the coronary care unit via emergency ambulance. The patient was subjected to a battery of urgent investigations which were all normal. Also an urgent coronary angiogram was undertaken which showed completely normal coronary anatomy.
SUMMARYWe describe a rare case of inappropriate implantable cardioverter defibrillator (ICD) therapy due to false sensing of electromechanical interference from diathermy as 'ventricular fibrillation (VF)'. This occurred during surgical removal of sternal wires under general anaesthesia. Postsurgical interrogation of ICD revealed the intracardiac electrogram showing the mechanical interference sensed as 'VF' by ICD and subsequent shock delivery.
BACKGROUND
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