[Eructonesius: a little known symptom of myocardial ischaemia]

A timely diagnosis of myocardial ischaemia is important. However, patients frequently present with rather atypical complaints. Eructonesius, or belching, is such an atypical complaint but may be considered an equivalent of angina.

A 86-year-old male with known arterial hypertension was referred with longstanding eructonesius. The complaint was initially clearly exercise-induced, but over time the belching became more intense and appeared in rest. No other cardiac or gastro-intestinal complaints were present. Gastro-intestinal examinations were uneventful. Ultimately, typical angina pectoris appeared and the patient was referred for cardiac examination. Coronary angiography revealed a significant stenosis on the circumflex artery, which was subsequently stented. After the procedure, the patient became completely asymptomatic.

Myocardial ischaemia does not necessarily present with typical angina. More often patients present with vague, atypical complaints. Therefore, a low-threshold to consider myocardial ischaemia in the differential diagnosis of such complaints remains important, especially if other diagnostic clues are present.