In the appropriate clinical context, ST-segment elevation on electrocardiogram (ECG) necessitates prompt evaluation for coronary artery occlusion requiring reperfusion with percutaneous coronary intervention. Conversely, the etiology of ST-segment elevation may be representative of an alternative diagnosis other than myocardial infarction. We report the case of a patient with a history of primary bone sarcoma who presented for further evaluation of a large pericardial effusion identified on an outpatient echocardiogram and was found to have ST-segment elevation on ECG in the absence of any cardiopulmonary symptoms. The ECG abnormalities were attributed to a likely persistent current of injury resulting from a mass in the interventricular septum, likely representative of a metastatic lesion of his known malignancy. This case highlights the importance of maintaining a broad differential for ST-segment elevation, particularly in patients without symptoms of angina and those with a history of aggressive or relapsing cancer to minimize the morbidity and mortality of invasive procedures.
Background and purpose: Fewer than 1 in 20 patients with acute ischemic stroke are treated with thrombolytic drugs, with threequarters of otherwise eligible patients being excluded secondary to delay in seeking medical treatment. Lack of symptom recognition may contribute to low treatment rates and is an important focus of public health education. The purpose of this study was to determine if an individual's cumulative number of stroke risk factors correlated with their ability to identify stroke symptoms. Methods: We surveyed adults about their stroke risk factors and knowledge of stroke symptoms at grocery stores and malls in a medium-sized university town in the Midwestern US. Results: In total, 245 adults completed surveys. Self-reported risk factors included high blood pressure (25%), high cholesterol (22%), diabetes (12%), tobacco use (11%), alcohol use (7%), heart disease (7%), and prior stroke (3%). Cumulatively, 56% of respondents had no risk factors, 41% had 1Á3 risk factors, and 4% had 4' risk factors. When administered a six-point stroke symptom knowledge test, respondents with 4' risk factors were significantly less knowledgeable, receiving a mean score of 3.2, compared to those with 1Á3 risk factors, who scored a mean of 4.6. Those with four or more years of college were significantly more knowledgeable than those with only a high-school education, receiving mean scores of 4.6 and 3.9, respectively. There was no association between stroke knowledge and use of a primary care physician. Conclusions: Although it is known that individuals with more risk factors are more likely to have a stroke, in our study these respondents were less able to recognize stroke symptoms compared to respondents with fewer risk factors. Future public stroke awareness campaigns should be targeted toward those most at risk so they learn to recognize stroke symptoms and thus seek treatment in a timely manner.
Takotsubo cardiomyopathy is characterized by transient loss of systolic function in the absence of coronary artery disease. It is significantly more common in post-menopausal women and is typically brought on by intense emotional stress. Pathophysiology is not completely elucidated, but it appears to be related, in part, to excess catecholamine; this results in coronary artery vasospasm, ischemia and eventual ventricular dysfunction. Patient presentation can vary widely, but typically presents similar to acute coronary syndrome. Management involves acute stabilization and monitoring, as well as guideline-directed medical therapy for heart failure. We report a very unique case of a healthy male patient presenting with nonanginal symptoms of racing heart, who was found to have cardiomyopathy following a physical encounter. This case serves to bring into awareness that intense physical encounters may be sufficient to induce cardiomyopathy without presenting angina.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.