Related Experiment Video

Updated: May 2, 2026

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

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Acute coronary ischemia identified by EMS providers in a standing middle-aged male with atypical symptoms

David W Ross, Chris Cooperrider, Mark B Homan

    Prehospital Emergency Care
    |March 8, 2014
    PubMed

    Insights

    This case study highlights a rare instance of acute coronary syndrome in a healthy middle-aged male. Atypical symptoms, including syncope and positional electrocardiographic changes, preceded ventricular tachycardia.

    Area of Science:

    • Cardiology
    • Internal Medicine
    • Emergency Medicine

    Background:

    • Acute coronary syndrome (ACS) and myocardial infarction (MI) can present atypically in specific patient groups.
    • Atypical presentations are less common in middle-aged males without significant comorbidities.

    Observation:

    • A 53-year-old male with no prior medical history, except chronic back pain, presented with syncope and lightheadedness.
    • Emergency medical services noted intermittent lightheadedness and syncope.
    • Electrocardiographic changes indicative of acute ischemia were only evident when the patient was in a standing position.

    Findings:

    • The patient experienced ventricular tachycardia that progressed to ventricular fibrillation.
    • Positional electrocardiographic changes suggested occult acute cardiac ischemia.
    • A coronary artery lesion was confirmed as the cause.

    Implications:

    • This case underscores the importance of considering ACS in patients with atypical symptoms, even in the absence of traditional risk factors.
    • Positional electrocardiographic changes may indicate occult cardiac ischemia and warrant further investigation.
    • The unique presentation challenges typical diagnostic paradigms for acute coronary syndrome.

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