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10p for an angiogram: the cardio-oesophageal reflex
S R Kandan1, D X Augustine, R J Mansfield
1Department of Cardiology, Royal United Hospital, Bath, UK. raveenkandan@gmail.com
BMJ Case Reports
|July 17, 2012
Summary
A swallowed coin caused chest pain and ECG changes mimicking unstable angina. The patient recovered fully after the coin passed naturally, highlighting rare causes of cardiac symptoms.
Area of Science:
- Internal Medicine
- Cardiology
- Gastroenterology
Background:
- Central chest pain and electrocardiogram (ECG) abnormalities can indicate acute coronary syndromes.
- Differential diagnosis is crucial, as non-cardiac conditions can present with similar symptoms.
Observation:
- A 57-year-old male presented with central chest pain and ECG findings suggestive of unstable angina.
- Coronary angiography unexpectedly identified a radio-opaque foreign body in the xiphisternal region.
- Oesophogastroduodenoscopy confirmed the object to be a swallowed 10p coin.
Findings:
- The ingested 10p coin traversed the gastrointestinal tract without complications.
- Resolution of the patient's chest pain and ECG abnormalities occurred spontaneously after coin passage.
Implications:
- This case underscores the importance of considering unusual etiologies for symptoms mimicking acute coronary syndrome.
- Foreign body ingestion should be included in the differential diagnosis for patients presenting with unexplained chest pain and dynamic ECG changes.
- Illustrates how gastrointestinal issues can present with cardiac-like symptoms, necessitating a broad diagnostic approach.
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