ST-Segment Elevation Myocardial Infarction with Acute Stent Thrombosis Presenting as Intractable Hiccups: An Unusual
Fan Zhang1, Nosakhare Douglas Tongo1, Victoria Hastings2
1Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA.
Insights
Intractable hiccups can signal acute myocardial infarction (MI), even in atypical presentations. This case highlights cocaine-induced MI as a rare cause of persistent hiccups, emphasizing the need for comprehensive cardiac evaluation.
Area of Science:
- Cardiology
- Neurology
Background:
- Acute coronary syndrome (ACS) can manifest with atypical symptoms beyond chest pain, such as indigestion.
- Persistent hiccups are often overlooked as a symptom of serious underlying conditions, including cardiac disease.
Observation:
- A 51-year-old male presented with intractable hiccups preceding and following stent placement for cocaine-related myocardial infarction (MI).
- Coronary angiography revealed in-stent thrombosis, which resolved after thrombectomy, angioplasty, and stenting.
Findings:
- Hiccups, associated with elevated cardiac enzymes and EKG ST-segment elevation, can be a manifestation of acute MI.
- Cocaine use may contribute to myocardial ischemia through sympathomimetic vasoconstriction, potentially explaining the unusual presentation.
Implications:
- This case underscores the importance of considering acute MI in patients with persistent hiccups, especially those with cardiac risk factors or substance use.
- Comprehensive cardiac evaluation, including coronary angiography, is crucial for diagnosing and managing MI presenting with atypical symptoms like intractable hiccups.
Abstract:
BACKGROUND Acute coronary syndrome (ACS) can present with atypical chest pain or symptoms not attributed to heart disease, such as indigestion. Hiccups, a benign and self-limited condition, can become persistent or intractable with overlooked underlying etiology. There are various causes of protracted hiccups, including metabolic abnormalities, psychogenic disorders, malignancy, central nervous system pathology, medications, pulmonary disorders, or gastrointestinal etiologies. It is rarely attributed to cardiac disease. CASE REPORT We report a case of intractable hiccups in a 51-year-old male with cocaine related myocardial infarction (MI) before and after stent placement. Coronary angiogram showed in-stent thrombosis of the initial intervention. Following thrombectomy, balloon angioplasty, and stent, the patient recovered well without additional episodes of hiccups. Although hiccups are not known to present with a predilection for a particular cause of myocardial ischemia, this case may additionally be explained by the sympathomimetic effects of cocaine, which lead to vasoconstriction of coronary arteries. CONCLUSIONS Hiccups associated with cardiac enzyme elevation and EKG ST-segment elevation before and after percutaneous coronary intervention (PCI) maybe a manifestation of acute MI with or without stent. The fact that this patient was a cocaine user may have contributed to the unique presentation.
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