Acute Coronary Syndrome Presenting With Hiccups
Jacquelyn Hovey1, Talha Perwez2, Prudhvi Regula2
1Internal Medicine, University of Alabama at Birmingham (UAB) School of Medicine, Montgomery, USA.
Insights
Persistent hiccups can signal acute coronary syndrome (ACS), a serious heart condition. This case highlights the importance of considering cardiac causes for unexplained, prolonged hiccups in at-risk patients.
Area of Science:
- Cardiology
- Neurology
Background:
- Acute coronary syndrome (ACS) often presents with classic chest pain.
- Atypical symptoms of ACS can include various non-cardiac complaints.
- Persistent hiccups are rarely recognized as a potential indicator of myocardial ischemia.
Observation:
- A 62-year-old male with hypertension, type II diabetes mellitus, and prior ischemic stroke presented with persistent hiccups.
- Coronary angiography revealed severe triple vessel coronary artery disease.
- Hiccups resolved post-coronary artery bypass graft surgery.
Findings:
- This case represents the first reported instance of hiccups as a primary symptom of severe triple vessel coronary artery disease.
- The persistent hiccups are hypothesized to result from phrenic nerve irritation due to myocardial infarction, activating the hiccup reflex arc.
Implications:
- Highlights a rare but significant association between persistent hiccups and acute coronary syndrome.
- Emphasizes the need for a high index of suspicion for cardiac ischemia in patients presenting with unexplained, persistent hiccups, particularly the elderly and those with cardiovascular risk factors.
Abstract:
Acute coronary syndrome can present with atypical symptoms. Hiccups, generally considered benign and self-limiting, can be an indicator of myocardial ischemia if persistent. We present the case of a 62-year-old gentleman with a past medical history significant for hypertension, type II diabetes mellitus, and ischemic stroke who presented with persistent hiccups. Coronary angiogram revealed severe triple vessel disease and he underwent coronary artery bypass graft surgery, following which his hiccups resolved. There are very few cases that report the association of hiccups and myocardial ischemia. To our knowledge, this is the first reported case in which hiccups were a part of the primary symptoms associated with severe triple vessel coronary artery disease. This could be due to irritation of the phrenic nerve from the infarcted myocardium resulting in activation of the hiccup reflex arc. Our case highlights the association between these two common entities and stresses the importance of having a high index of suspicion, especially among high-risk and elderly patients.
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