Pain in the Left Ear as the Presenting Symptom of Acute Myocardial Infarction in a Renal Transplant Recipient

Bašić‐Jukić, Nikolina; D, Novosel; Ivanac, Irena; Đanić-Hadžibegović, Ana; Kes, Petar

doi:10.1016/j.transproceed.2014.01.001

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…Only one reported case of ST-segment elevation myocardial infarction presenting as otalgia was reported. 12 This is consistent with reports of myocardial infarction presenting with atypical chest pain symptoms in patients who are older, more frequently women and with diabetes or heart failure. 16 …”

Section: Discussionsupporting

confidence: 91%

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Myocardial Infarction Presenting as Ear Fullness and Pain

Ugalde

Anjum

Presti

et al. 2018

Journal of Investigative Medicine High Impact Case Reports

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Acute coronary syndrome usually presents with retrosternal chest pain, nausea, vomiting, sweating, and jaw and arm pain. Some patients only present with neck, epigastric, or ear discomfort. A 47-year-old male with a history of hypertension and coronary artery disease presented to the emergency department complaining of bilateral otalgia. He never felt chest pain, jaw pain, nausea, diaphoresis, or shortness of breath. He had a history of 2 acute coronary events and had a stress test 2 months prior to admission, which was unremarkable. The initial electrocardiography was sinus rhythm with Q-waves in the inferior leads and nonspecific ST changes in the lateral leads. His troponin on admission was normal but subsequently elevated to 20.00 mg/mL after 24 hours. He underwent left heart catheterization, which found significant occlusive disease of the second and fourth obtuse marginal branches and 2 drug-eluting stents were placed. His ear pain resolved soon after cardiac catheterization. The pathophysiology of this referred pain is thought to be related to the neuroanatomy of the nerves innervating the heart and ear. The auricular nerve branch of the vagus nerve supplies the inner portion of the external ear. Only a few cases with the complaint of otalgia have been reported. Patients were older, more frequently women, and with diabetes or heart failure. Clinicians should be aware of the atypical presentation of angina that may be life-threatening cardiac ischemia. Ear pain and fullness could be the sole presenting symptom in a patient with acute coronary syndrome.

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Section: Discussionsupporting

confidence: 91%

“…Only a few cases with the complaint of otalgia but not with ear fullness have been reported. 7 , 11 - 15 A review of literature found the age of presentation was above 50 years with delayed diagnosis as other conditions were higher on the differential. Patients commonly had comorbidities such as heart failure or diabetes.…”

Section: Discussionmentioning

confidence: 99%

Myocardial Infarction Presenting as Ear Fullness and Pain

Ugalde

Anjum

Presti

et al. 2018

Journal of Investigative Medicine High Impact Case Reports

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“…[Reference] N (sex/age in years) Atypical symptoms Comorbidities Madias et al (2002) [12] Two (M/75, M/62) [19] One (M/83) Severe and diffuse bone pain DM Siau K. (2009) [20] One (M/61) Pain along the medial aspect of his left thigh Recurrent reflux oesophagitis Kohli et al (2010) [21] One (F/66) Sudden onset of slurred speech preceded by dizziness and vomiting None Amirhaeri et al (2010) [22] One (F/53) Earache and sore throat Smoker, dyslipidemia, DM, post-PCI Davenport et al (2012) [23] One (M/68) Intractable hiccups causing insomnia DM, HTN, tobacco use Her et al (2012) [24] One (F/54) Atypical chest pain Papillary fibroelastoma of the aortic valve Holm et al (2012) [25] One (M/48) Leg pain due to arterial occlusion Smoking Khoroshikh (2013) [26] One (M/57) Atypical hand pain, shortness of breath while walking HTN, hypercholesterolemia, smoking Abdalla et al (2014) [27] One (M/65) Progressive dyspnoea, presyncope Morbid obesity, post gastric bypass, depression, alcohol dependence Basic-Jukic et al (2014) [28] One (M/55) Otalgia on post-op renal transplant day three DM, coronary stent, post-renal transplant Dundar et al (2014) [29] One (F/87) Otalgia with sweating on head and neck DM Petrović et al (2014) [30] One (M/63) TIA without chest pain, sinus tachycardia HTN, smoking Parekh et al (2014) [31] One (M/55) Unexplained lethargy and anxiety CAD, post-stent, and on dual antiplatelet Wang et al (2014) [32] One (M/79) Abdominal pain and fever Gastric villous adenoma, TTP Ajayi et al (2015) [33] One (M/58) Shortness of breathing, aphasia, with hypoxia Prostate cancer, HTN, hyperlipidemia, peripheral vascular disease, alcoholism, and past-smoker Taylor (2015) [34] One (M/44 [59] One (M/28) Retrosternal atypical chest pain Marfan syndrome, post aortic root and arch replacement Kirchner (2022) [60] One (F/47) Stressed, jaw pain None…”

Section: Authors (Year)mentioning

confidence: 99%

Atypical Presentations of Myocardial Infarction: A Systematic Review of Case Reports

Khan¹,

Karim²,

Panda³

et al. 2023

Cureus

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There is a rising incidence of coronary artery diseases and myocardial infarction (MI). Mortality associated with acute MI (AMI) is directly linked to the time to receive treatment and missed diagnoses. Although health professionals are aware of typical AMI presentation, atypical MI is difficult to diagnose, which on the other hand, is likely to have an impact on morbidity and mortality. Therefore, it is prudent to know such atypical presentations, especially for emergency and primary care physicians. We aimed to systematically evaluate the clinical presentations of atypical MI and analyze them to characterize the common clinical presentations of atypical MI. We researched the PubMed database, did citation tracking, and performed Google Scholar advanced search to find the cases reported on the atypical presentation of MI published from January 2000 to September 2022. Articles of all languages were included; Google Translate was used to translate articles published in languages other than English. A total of 496 (56 PubMed articles, 340 citations from included PubMed articles, and 100 articles from Google Scholar advanced search) were screened; 52 case reports were evaluated, and their data were analyzed. Atypical presentations of myocardial infarction are vast; patients may have chest pain without typical characteristics of angina pain or may not have chest pain. No typical characterization could be done. Most patients were in their fifth decade or above of their life and commonly presented with pain and discomfort in the abdomen, head, and neck regions. Prodromal symptoms were consistent findings, and many patients had two to three comorbidities out of four common comorbidities, i.e., diabetes, hypertension, dyslipidemia, and substance abuse. A patient who is 50 years old or more, having comorbidities such as diabetes, hypertension, dyslipidemia, history of tobacco or marijuana usage, presenting with prodromal symptoms like shortness of breath, dizziness, fatigue, syncope, gastrointestinal discomfort or head/neck pain should be suspected for atypical MI.

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