Myocardial Infarction Presenting as Ear Fullness and Pain

Area of Science:

• Cardiology
• Neurology
• Emergency Medicine

Background:

• Acute coronary syndrome (ACS) typically manifests as chest pain, but atypical presentations occur.
• Referred pain from cardiac events can involve various sites, including the ear.
• Previous cardiac events and hypertension are risk factors for ACS.

Purpose of the Study:

• To report a case of ACS presenting solely with bilateral otalgia.
• To emphasize the importance of recognizing atypical ACS symptoms.
• To discuss the neuroanatomical basis of referred otalgia in ACS.

Main Methods:

• Case report of a 47-year-old male with a history of coronary artery disease.
• Clinical presentation, electrocardiography (ECG), cardiac biomarkers (troponin), and left heart catheterization.
• Resolution of otalgia following cardiac intervention.

Main Results:

• The patient presented with bilateral ear pain as the sole symptom, with no typical chest pain.
• ECG showed inferior Q-waves and nonspecific ST changes; troponin levels elevated post-admission.
• Left heart catheterization revealed significant coronary artery disease, treated with drug-eluting stents.
• Ear pain resolved after stent placement.

Conclusions:

• Otalgia can be the exclusive presenting symptom of acute coronary syndrome.
• Clinicians must consider ACS in patients with unexplained ear pain, especially those with cardiac risk factors.
• Understanding the neuroanatomy of referred pain is crucial for diagnosing atypical ACS presentations.