Could contrast-enhanced CT detect STEMI prior to electrocardiogram?

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Myocardial infarction (MI) diagnosis typically relies on electrocardiogram (ECG) and troponin levels.
• Atypical presentations and normal initial ECGs can complicate MI diagnosis.
• Contrast-enhanced computed tomography (CT) offers high-resolution imaging of cardiac structures.

Observation:

• A patient presented with atypical symptoms suggestive of MI but had a normal ECG on admission.
• Contrast-enhanced CT was the initial diagnostic modality used.
• The CT scan revealed evidence of myocardial hypoperfusion.

Findings:

• A subsequent ECG showed ST-segment elevation, and troponin levels were elevated.
• Coronary angiography confirmed occlusion of the left anterior descending artery.
• Percutaneous coronary intervention was performed after failed thrombolysis.

Implications:

• High-resolution contrast-enhanced CT may serve as an early diagnostic tool for suspected MI, especially with normal initial ECGs.
• Further research is needed to establish the role of CT in MI workup alongside or as an alternative to coronary angiography.
• This case highlights the potential of advanced imaging in identifying acute coronary syndromes with non-specific initial findings.