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Neth Heart J
v.16(10); 2008 Oct
PMC2570763
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Neth Heart J. 2008 Oct; 16(10): 325–331.
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
Correspondence to: Y.L. Gu, Department of Cardiology, University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB Groningen, the Netherlands ln.gcmu.xaroht@ug.l.y :liamE
Copyright © Bohn Stafleu van Loghum
Keywords: ST-segment elevation myocardial infarction, differential diagnosis, coronary angiography, percutaneous coronary intervention
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30. Terkelsen CJ, Lassen JF, Norgaard BL, et al. Reduction of treatment delay in patients with ST-elevation myocardial infarction: impact of pre-hospital diagnosis and direct referral to primary percutaneous coronary intervention. Eur Heart J 2005; 26 :770-7. [ PubMed ] [ Google Scholar ]
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32. van 't Hof AW, Rasoul S, van de Wetering H, et al. Feasibility and benefit of prehospital diagnosis, triage, and therapy by paramedics only in patients who are candidates for primary angioplasty for acute myocardial infarction. Am Heart J 2006; 151 :1255-5.e5. [ PubMed ] [ Google Scholar ]
Articles from Netherlands Heart Journal are provided here courtesy of Springer
1. Bradley EH, Herrin J, Wang Y, et al. Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med 2006; 355 :2308-20. [ PubMed ] [ Google Scholar ] [ Ref list ]
4. DeWood MA, Spores J, Notske R, et al. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med 1980; 303 :897-902. [ PubMed ] [ Google Scholar ] [ Ref list ]
5. Widimsky P, Stellova B, Groch L, et al. Prevalence of normal coronary angiography in the acute phase of suspected ST-elevation myocardial infarction: experience from the PRAGUE studies. Can J Cardiol 2006; 22 :1147-52. [ PMC free article ] [ PubMed ] [ Google Scholar ] [ Ref list ]
8. Wang K, Asinger RW, Marriott HJ. ST-segment elevation in conditions other than acute myocardial infarction. N Engl J Med 2003; 349 :2128-35. [ PubMed ] [ Google Scholar ] [ Ref list ]
9. Bertrand ME, Simoons ML, Fox KA, et al. Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2002; 23 :1809-40. [ PubMed ] [ Google Scholar ] [ Ref list ]
12. Livaditis IG, Paraschos M, Dimopoulos K. Massive pulmonary embolism with ST elevation in leads V1-V3 and successful thrombo-lysis with tenecteplase. Heart 2004; 90 :e41. [ PMC free article ] [ PubMed ] [ Google Scholar ] [ Ref list ]
14. Ryan ET, Pak PH, DeSanctis RW. Myocardial infarction mimicked by acute cholecystitis. Ann Intern Med 1992; 116 :218-20. [ PubMed ] [ Google Scholar ] [ Ref list ]
16. Bouten MJ, Simoons ML. Strategies for pre-hospital thrombo-lysis: an overview. Eur Heart J 1991;12 ( Suppl G ):39-42. [ PubMed ] [ Google Scholar ] [ Ref list ]
17. Brugada P, Brugada J. Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol 1992; 20 :1391-6. [ PubMed ] [ Google Scholar ] [ Ref list ]
19. Costantini M,Tritto C, Licci E, et al. Myocarditis with ST-Elevation Myocardial Infarction presentation in young man. A case series of 11 patients. Int J Cardiol 2005; 101 :157-8. [ PubMed ] [ Google Scholar ] [ Ref list ]
20. Ozeke O, Aras D, Deveci B, Yildiz A, Maden O, Selcuk MT. Brugada-like early repolarization pattern misdiagnosed as acute anterior myocardial infarction in a patient with myocardial bridging of the left anterior descending artery. Mt Sinai J Med 2006; 73 :627-30. [ PubMed ] [ Google Scholar ] [ Ref list ]
22. Antman EM, Braunwald E. ST-elevation myocardial infarction: pathology, pathophysiology, and clinical features. In: Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's heart disease: a textbook of cardiovascular medicine. Philadelphia, PA: Elsevier Saunders; 2005:1141-65. [ Google Scholar ] [ Ref list ]
27. Lee TH, Cannon CP. Approach to the patient with chest pain. In: Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's heart disease: a textbook of cardiovascular medicine. Philadelphia, PA: Elsevier Saunders; 2005:1129-39. [ Google Scholar ] [ Ref list ]
29. Khoury NE, Borzak S, Gokli A, Havstad SL, Smith ST, Jones M. “Inadvertent” thrombolytic administration in patients without myocardial infarction: clinical features and outcome. Ann Emerg Med 1996; 28 :289-93. [ PubMed ] [ Google Scholar ] [ Ref list ]
31. Larson DM, Menssen KM, Johnson RK, et al. False positive ST elevation in patients undergoing direct percutaneous coronary intervention. Circulation 2006; 114 :II-346 [ Google Scholar ] [ Ref list ]
32. van 't Hof AW, Rasoul S, van de Wetering H, et al. Feasibility and benefit of prehospital diagnosis, triage, and therapy by paramedics only in patients who are candidates for primary angioplasty for acute myocardial infarction. Am Heart J 2006; 151 :1255-5.e5. [ PubMed ] [ Google Scholar ] [ Ref list ]
23. Blankenship JC, Almquist AK. Cardiovascular complications of thrombolytic therapy in patients with a mistaken diagnosis of acute myocardial infarction. J Am Coll Cardiol 1989; 14 :1579-82. [ PubMed ] [ Google Scholar ] [ Ref list ]
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A rapid diagnosis of ST-segment elevation myocardial infarction (STEMI) is mandatory for optimal treatment. However, a small proportion of patients with suspected STEMI suffer from other conditions. Although case reports have described these conditions, a contemporary systematic analysis is lacking. We report the incidence, clinical characteristics and outcome of patients with suspected STEMI referred for primary percutaneous coronary intervention (PCI) with a final diagnosis other than STEMI.
From January 2004 to July 2005, 820 consecutive patients were included with suspected STEMI who were referred for primary PCI to a university medical centre, based on a predefined protocol. Clinical characteristics, final diagnosis and outcome were obtained from patient charts and databases.
In 19 patients (2.3%), a final diagnosis other than myocardial infarction was established: coronary aneurysm (n=1), (myo)pericarditis (n=5), cardiomyopathy (n=2), Brugada syndrome (n=1), aortic stenosis (n=1), aortic dissection (n=3), subarachnoidal haemorrhage (n=2), pneumonia (n=1), chronic obstructive pulmonary disease (n=1), mediastinal tumour (n=1), and peritonitis after recent abdominal surgery (n=1). These patients less often reported previous symptoms of angina (p<0.001), smoking (p<0.05) and a positive family history of cardiovascular diseases (p<0.05) than STEMI patients. Mortality at 30 days was 16%.
A 2.3% incidence of conditions mimicking STEMI was found in patients referred for primary PCI. A high clinical suspicion of conditions mimicking STEMI remains necessary. ( Neth Heart J 2008; 16 :325-31. [ PMC free article ] [ PubMed ] [ Google Scholar ] )
A rapid and accurate diagnosis of acute ST-segment elevation myocardial infarction (STEMI) is of crucial importance as early initiation of primary percutaneous coronary intervention (PCI) is beneficial to patients. 1-3 In general, plaque rupture or plaque erosion and subsequent platelet aggregation and thrombosis resulting in acute occlusion of a coronary artery is considered the main mechanism of STEMI. 4 However, coronary arteries without any stenosis have been reported in 2.6% of patients with suspected STEMI on acute diagnostic coronary angiography (CAG). 5 Although some of these patients may actually suffer from myocardial infarction resulting merely from coronary spasm or a thrombus, 5-7 others may have alternative diseases and conditions.
Various conditions may present with an identical electrocardiographic pattern as STEMI in clinical practice. 8 First, transient ST-segment elevation can be present in acute coronary syndromes, especially in patients with significant coronary artery stenosis but no total occlusion. 9 Second, cardiac conditions not affecting the coronary arteries, such as pericarditis and myocarditis, can also present in an infarction-like manner. 8,10,11 A third group of conditions which sometimes have a STEMI-like presentation are of vascular origin, such as pulmonary embolism and aortic dissection. 12,13 Finally, noncardiac conditions such as acute cholecystitis or pancreatitis may also mimic STEMI. 14,15
Although these conditions simulating STEMI have been described in the literature, in particular in case reports, a contemporary systematic analysis is lacking with regard to the incidence and clinical features of conditions mimicking STEMI in patients referred for primary PCI. This study was performed to document the incidence, clinical characteristics as well as the outcome of patients with suspected STEMI and referred for primary PCI who had a final diagnosis other than STEMI.
From 1 January 2004 to 30 July 2005,820 consecutive patients with suspected STEMI referred for primary PCI were included in a registry of patients treated at our catheterisation laboratory. The setting of the study was a university medical centre with 24-hour primary PCI facilities providing emergency care with seven referral hospitals in a region with 750,000 inhabitants. Based on an agreement between cardiologists, all patients with suspected STEMI in this region were transported, referred and treated in our hospital in accordance with an ambulance paramedics driven and computer assisted STEMI protocol. Patients with (1) symptoms suggestive of myocardial infarction for at least 30 minutes, with (2) a time from onset of symptoms of less than 12 hours before presentation and with (3) an electrocardiogram (ECG) with ST-segment elevation of more than 0.1 mV in two or more leads or suspected new onset bundle branch block were transported to our catheterisation laboratory for acute CAG and subsequent primary PCI. The results of the initial assessment were sent by fax to the coronary care unit as well as the interventional cardiologist at the catheterisation laboratory. This strategy has been described previously. 16 Upon this action, the catheterisation laboratory was activated. Whenever a diagnosis of STEMI was doubted, communication was established between the ambulance and the coronary care unit. Based on clinical judgement in combination with the information from the ECG, a decision to proceed to the catheterisation laboratory was taken. In the ambulance, aspirin (500 mg), clopidogrel (300 mg), and heparin (5000 IU) were administered. For patients presenting in referral hospitals, a similar medication regimen was followed.
Clinical features and outcome of patients were obtained by patient chart and database review and enquiry at the referral hospitals. Patient data were reviewed individually by two authors and consensus was reached in all cases. The following data were collected: age, ge
Сексуальная модель со стажем снимает свой влажный купальник на пляже
Испанка делает селфи прикрывая сиськи руками
Две сексапильные горничные ублажают мужчину