Case Report: From Irregular Hiccups to Acute Myocardial Infarction
Kamiar Kersten Rueckert1, Adrian Willersinn1
1Department of Cardiology and Angiology, St. Josefskrankenhaus Heidelberg, Heidelberg, Germany.
Insights
Acute coronary syndrome can be missed with normal electrocardiogram (ECG) findings. High-sensitive troponin testing is crucial for diagnosing myocardial infarction in patients with atypical symptoms like hiccups.
Area of Science:
- Cardiology
- Emergency Medicine
- Diagnostic Imaging
Background:
- Electrocardiogram (ECG) is primary for acute coronary syndrome (ACS) diagnosis.
- Normal ECGs can mask ACS, leading to missed diagnoses.
- High-sensitive troponin assays are vital for patients with atypical presentations.
Observation:
- A 53-year-old man presented with 3 weeks of persistent hiccups, nausea, and burping.
- Initial presentation was to a general practitioner, later transferred to the emergency department.
- High-sensitive troponin T levels were significantly elevated at 989 pg/mL.
Findings:
- The elevated high-sensitive troponin T confirmed a diagnosis of acute coronary syndrome.
- The troponin algorithm aids in identifying ACS, particularly with elevated creatine kinase and lactate dehydrogenase.
- The 2015 European Society of Cardiology troponin algorithm is critical for diagnosis.
Implications:
- Timely diagnosis of ACS through troponin testing can facilitate prompt reperfusion therapy.
- Improved patient outcomes are associated with early detection and treatment of myocardial infarction.
- Increased awareness of uncommon symptoms like hiccups in ACS diagnosis is essential.
Introduction:
The electrocardiogram (ECG) is the key player in the diagnosis of an acute coronary syndrome. In the light of normal ECG findings, the diagnosis can be missed. The high-sensitive troponin is a necessary laboratory value for patients with uncommon symptoms.
Case Presentation:
A 53-year-old man without a history of coronary heart disease initially presented to his general practitioner with persistent hiccups for 3 weeks. In the emergency department, the patient complained of nausea and burping. The high-sensitive troponin T was 989 pg/mL and led to the diagnosis of an acute coronary syndrome.
Conclusion:
The troponin algorithm helps to identify this patient group, especially in the setting of elevated creatine kinase and lactate dehydrogenase. Awareness of these symptoms can help lead to a timely reperfusion therapy and thus improved outcomes. The 2015 European Society of Cardiology algorithm for troponin may not only help for the initial diagnosis, but rather should be regarded as crucial.
