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Acute Coronary Syndrome I: Introduction01:30

Acute Coronary Syndrome I: Introduction

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Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
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Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations01:19

Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations

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The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
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Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

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Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
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Myocarditis II: Clinical Features and Diagnostic Tests01:27

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Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...
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Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT01:25

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Calcium-Scoring CT ScanA calcium-scoring CT scan, also known as coronary artery calcium (CAC) scan, detects calcium deposits in the coronary arteries. This test assesses the risk of coronary artery disease (CAD), which can lead to cardiovascular events such as angina, heart failure, and sudden cardiac arrest.A calcium-scoring CT scan is generally recommended for individuals at intermediate risk of CAD without symptoms. It includes:Men aged 40-75 and women aged 50-75: Especially those with a...
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Angina III: Clinical Manifestations and Assessment01:29

Angina III: Clinical Manifestations and Assessment

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Angina manifests as chest pain, tightness, or squeezing discomfort typically located behind the breastbone. It can radiate to the neck, jaw, shoulders, and inner aspects of the upper arms, most commonly the left arm. Patients may experience shortness of breath, fatigue, profuse sweating, dizziness, indigestion, heartburn, palpitations, anxiety, and vomiting as accompanying symptoms. This pain often lasts a few minutes and is triggered by physical exertion, emotional stress, heavy meals, or cold...
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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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Case report: Severe hypercalcemia mimicking ST-segment elevation myocardial infarction.

Robert C Schutt1, John Bibawy1, Mina Elnemr1

  • 1Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.

Methodist Debakey Cardiovascular Journal
|January 10, 2015
PubMed
Summary

ST-segment elevation on ECGs can indicate cardiac issues, but may also signal noncardiac causes like hypercalcemia. This case highlights hypercalcemia as a cause of ST-segment elevation in a cancer patient.

Keywords:
STEMIelectrocardiogramhypercalcemia

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Area of Science:

  • Cardiology
  • Oncology
  • Internal Medicine

Background:

  • ST-segment elevation on electrocardiograms (ECGs) is crucial for diagnosing acute myocardial infarction.
  • However, ST-segment elevation can be mimicked by various non-ischemic cardiac and non-cardiac conditions.
  • Recognizing these mimics is essential for appropriate patient management and avoiding unnecessary interventions.

Observation:

  • A patient with metastatic cancer presented with symptoms suggestive of cardiac ischemia.
  • Electrocardiogram revealed ST-segment elevation, a finding typically associated with acute coronary syndromes.
  • Laboratory investigations identified significant hypercalcemia as the underlying cause.

Findings:

  • The ST-segment elevation was directly attributed to severe hypercalcemia, not cardiac ischemia.
  • This case demonstrates a rare but critical non-cardiac cause of a significant ECG finding.
  • Metastatic cancer was the likely driver of the electrolyte disturbance.

Implications:

  • Clinicians must consider electrolyte abnormalities, particularly hypercalcemia, in the differential diagnosis of ST-segment elevation.
  • Prompt identification and management of hypercalcemia can prevent misdiagnosis of acute myocardial infarction.
  • This underscores the importance of a comprehensive diagnostic approach in patients with complex medical histories, including those with cancer.