The American journal of emergency medicine
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Globe rupture is visually dramatic in appearance for emergency clinicians and is a sight-threatening injury for the patient. It requires prompt ophthalmologic surgical intervention for optimal outcomes. Cases are typically the result of ocular trauma; however, this case highlights a rare instance of spontaneous globe rupture in a patient with an extensive ocular surgical history.
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Chest pain (CP) is the hallmark symptom for acute coronary syndrome (ACS) but is not reported in 20-30% of patients, especially women, elderly, non-white patients, presenting to the emergency department (ED) with an ST-segment elevation myocardial infarction (STEMI). ⋯ CP alone had highest specificity but lacked sensitivity. Adding other ACS chief complaints increased sensitivity but identified 2.2-fold more patients for ECGs. Achieving an ECG in 10 min for patients with ACS to identify all STEMIs will be challenging without introducing more complex risk calculation into clinical care.
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Case Reports
Allergic myocardial infarction (Kounis Syndrome)- non-ST elevation MI following Omnipaque contrast.
Kounis Syndrome is an acute coronary syndrome in the setting of mast cell activation. Mast cell activation can be due to anaphylaxis, anaphylactoid reaction, allergies, or hypersensitivities. Three reported variants of Kounis Syndrome include: vasospastic allergic angina, allergic myocardial infarction, and stent thrombosis. Herein, we described a case of Type 2 Kounis Syndrome following iodinated contrast infusion for a fistulogram, which manifested as a rare non-ST elevation myocardial infarction (NSTEMI).
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The Electrocardiogram (ECG) is a readily available non-invasive test used in the evaluation of a patient with angina. ECG artifacts are common and stem from a number of different reasons including lead placement and must be identified to appropriately manage patients. We present the case of an elderly patient for whom an ECG was performed to evaluate chest pain showing an abnormal waveform concerning for an ST elevation myocardial infarction (STEMI). Closer inspection of the ECG revealed a characteristic pattern documented in the literature known as Aslanger's Sign seen when an ECG lead is placed over an artery.
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Comment Letter
High-dose nitroglycerin infusion for acute pulmonary edema.