ST segment elevation in a patient presenting with renal colic pain
Zohair Al Aseri1, Owais M Suriya, Hossam A Hassan
1Department of Emergency Medicine and ICU, King Saud University, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. zalaseri@ksu.edu.sa
Summary
Transient ST segment elevation, typically indicating heart injury, can be caused by non-cardiac conditions. This case highlights renal stone pain as a rare cause, emphasizing the need for differential diagnosis beyond acute myocardial infarction.
Area of Science:
- Cardiology
- Nephrology
- Emergency Medicine
Background:
- ST segment elevation (STE) on electrocardiograms (ECGs) is a critical indicator of acute myocardial injury, often signifying ST-elevation myocardial infarction (STEMI).
- While ischemia is the primary cause of STE, various non-coronary etiologies exist, necessitating careful diagnostic evaluation.
- Rapid diagnosis of STEMI is crucial for timely reperfusion therapy, but misdiagnosis due to alternative causes can lead to unnecessary interventions.
Observation:
- A young male presented with acute loin pain, a symptom typically associated with renal pathology.
- Electrocardiogram (ECG) revealed transient ST segment elevation.
- Comprehensive cardiac workup, including coronary angiography, excluded acute coronary syndrome or coronary artery disease.
Findings:
- The patient's ST segment elevation resolved without cardiac intervention.
- Further investigation identified renal calculus (kidney stone) as the cause of the loin pain.
- The renal pathology was determined to be the etiological factor for the transient electrocardiographic ST segment elevation.
Implications:
- This case underscores that ST segment elevation is not pathognomonic for acute myocardial infarction and can arise from diverse non-cardiac conditions.
- Clinicians must consider a broad differential diagnosis in patients presenting with STE, especially when cardiac risk factors are absent or initial cardiac investigations are negative.
- Recognizing non-ischemic causes of STE, such as severe pain from renal stones, is vital to prevent misdiagnosis and inappropriate treatment of myocardial infarction.
Related Concept Videos
01:26Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations
Renal calculi, commonly termed kidney stones, are crystalline solid masses that form in the kidneys but can occur at any point within the urinary system, encompassing the kidneys, ureters, bladder, and urethra.The pathophysiology of renal stones involves several key factors: supersaturation of the urine with stone-forming constituents, changes in urine pH, a decrease in urine volume, and the presence of substances that promote or inhibit stone formation.Supersaturation of Urine: This is the...
01:28Urinary Tract Calculi V: Nursing Management
AssessmentSubjective Data: Obtain a detailed health history, including any recent or chronic urinary tract infections, periods of immobilization, previous episodes of renal calculi, and medical conditions such as gout, benign prostatic hyperplasia, or hyperparathyroidism. Review the medication history for drugs that may influence stone formation, including allopurinol, analgesics, loop diuretics, or thiazide diuretics. Document the use of long-term indwelling catheters and any past surgical...
01:30Urinary Tract Calculi III: Medical Management
The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
01:19Abdominal Regions and Quadrants
To promote clear communication, for instance, about the location of a patient's abdominal pain or a suspicious mass, anatomists and clinicians typically use imaginary lines to categorize the abdominopelvic cavity into either four quadrants or nine regions to identify organs in the cavity.
The simpler quadrants approach, which is more commonly used in medicine, subdivides the cavity with one horizontal and one vertical line that intersects at the patient's umbilicus (navel). The four quadrants...
The simpler quadrants approach, which is more commonly used in medicine, subdivides the cavity with one horizontal and one vertical line that intersects at the patient's umbilicus (navel). The four quadrants...
01:19Imaging Studies VII: Vascular Imaging
DefinitionRenal angiography, also known as renal arteriography, is an imaging technique used to obtain a comprehensive view of blood flow and the vascular structure of blood vessels in the kidneys and surrounding areas.PurposeRenal angiography detects blood vessel abnormalities in the kidneys, such as aneurysms, stenosis, thrombosis, vascular tumors, and renal artery stenosis. It evaluates kidney function and guides interventional treatments like angioplasty or stent placement.Pre-Procedure...
01:27Imaging Studies III: Computed Tomography
DefinitionComputed Tomography (CT) of the genitourinary (GU) tract is a non-invasive imaging modality that utilizes X-rays and computer processing to generate detailed cross-sectional images of the urinary system, encompassing the kidneys, ureters, bladder, and adjacent structures such as the adrenal glands.PurposeCT scans of the GU tract serve several diagnostic and therapeutic purposes, including:Diagnosis of Urinary Tract Diseases: Detects kidney stones, tumors, cysts, and congenital...