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Painless ischemia provoked by mental stress in the coronary care unit
S W Sharkey1, N B Aberg, L Trost
1Cardiology Division, Hennepin County Medical Center, Minneapolis, MN 55415, USA.
Insights
Mental stress can trigger acute myocardial ischemia, even in patients with severe coronary artery disease. Continuous ST segment monitoring in intensive care units (ICUs) is crucial for detecting silent ischemia.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Psychocardiology
Background:
- Severe three-vessel coronary artery disease poses a significant risk for acute myocardial ischemia.
- Mental stress is increasingly recognized as a precipitating factor for cardiac events.
Observation:
- A 30-year-old male with known severe coronary artery disease experienced cardiac arrest.
- Continuous ST segment monitoring revealed painless ST segment depression during a police interview.
- Coronary angiography confirmed severe three-vessel coronary artery disease.
Findings:
- The case highlights the utility of continuous ST segment monitoring in the Intensive Care Unit (ICU) for detecting silent myocardial ischemia.
- Mental stress was identified as a potential trigger for acute myocardial ischemia in this patient.
Implications:
- Continuous ST segment monitoring is valuable for early detection of ischemia in critically ill patients.
- Recognizing mental stress as a trigger for ischemia is essential for comprehensive patient management in the ICU.
Abstract:
A 30-year-old man suffered a cardiac arrest after setting fire to his home. Continuous ST segment electrocardiographic monitoring in the Coronary Care Unit detected painless ST segment depression during an interview with a police officer. At angiography, the patient proved to have severe three-vessel coronary artery disease. This case demonstrates the clinical value of continuous ST segment monitoring in the ICU. In addition, the case illustrates that mental stress is a potential trigger for acute myocardial ischemia in the ICU.