Acute epigastric pain unveiling biventricular myocardial infarction: A case report
Thierno Hamidou Diallo1, Raynatou Djafarou Boubacar1, Frederick Nana Yeboah1
1Department of Cardiology A, Ibn Sina University Hospital Center, Rabat, Morocco.
Insights
Delayed diagnosis of acute coronary syndromes (ACS) in diabetic patients with atypical symptoms can worsen outcomes. This case highlights biventricular infarction in a diabetic patient presenting with epigastric pain, emphasizing the need for prompt evaluation.
Area of Science:
- Cardiology
- Internal Medicine
- Medical Case Reports
Background:
- Acute coronary syndromes (ACS) are a leading cause of death, necessitating timely treatment.
- Early reperfusion therapy is crucial for improving patient prognosis in ACS.
- Diabetic patients often present with atypical symptoms, complicating early diagnosis and management.
Observation:
- A 54-year-old male with type 2 diabetes and smoking history presented with epigastric pain.
- Initial presentation was treated symptomatically, leading to a delay in definitive management.
- The patient was admitted 8 hours after initial symptom onset.
Findings:
- The patient was diagnosed with biventricular infarction.
- Inferior wall ischemia is associated with right ventricular myocardial infarction in nearly 50% of cases.
- Clinical outcomes of right ventricular infarction vary from hemodynamic stability to cardiogenic shock.
Implications:
- Atypical presentations of ACS in diabetic patients require heightened clinical suspicion.
- Prompt diagnosis and initiation of reperfusion therapy are critical for reducing morbidity and mortality.
- This case underscores the importance of considering myocardial infarction in diabetic patients presenting with non-specific symptoms.
Abstract:
Acute coronary syndromes are a clinical entity frequently encountered in practice and are responsible for significant morbidity and mortality, despite therapeutic advances. The initiation of early reperfusion therapy reduces mortality and morbidity and improves patients' prognosis, but this depends on how quickly patients receive their treatment. Although it is often easy to diagnose in the presence of typical symptoms, certain patients, such as diabetics, sometimes have atypical symptoms, resulting in a delay in management. In nearly 50% of cases, inferior wall ischaemia is accompanied by right ventricular myocardial infarction; the clinical outcomes range from no hemodynamic compromise to severe hypotension and cardiogenic shock. In this article, we present the case of a 54-year-old male patient with active smoking and poorly controlled type 2 diabetes as cardiovascular risk factors who initially consulted at the first hour for epigastric pain, for which he received symptomatic treatment. As the symptoms persisted, he was admitted to our department at the eighth hour, where he was diagnosed with a biventricular infarction.
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