acute coronary syndrome

Acute coronary syndrome after initiation of amoxicillin/clavulanate

Case Reports, Volume 22, Issue 1, Pages 1 – 56 (2023)

We report the case of a 54 year old man referred to the Emergency Department for rapid onset of an itchy rash and oppressive epigastric pain after assumption of amoxicillin/clavulanate. Electrocardiogram aand laboratory findings were consistent with acute coronaty syndrome. After coronary angiography, diagnosis of type II Kounis syndrome was made.

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Ventricular tachycardia and raised troponin: “What if it’s a pheochromocytoma”? Some lessons from a crisis

Case Reports, Volume 20, Issue 4, Pages 249 – 308 (2021)

A 63-year-old female with cardiovascular risk factors presented with tremor, sweating, lower back discomfort, nausea and dyspnoea. Electrocardiogram showed sinus tachycardia with lateral ST-depression. High-sensitivity troponin-T was dynamically elevated (72ng/L to 112ng/L on one-hour repeat). Overnight, there was an episode of ventricular tachycardia with further troponin rise to 364ng/L. Coronary angiogram demonstrated non-obstructive coronary artery disease. Post-procedure, the patient developed a hypertensive crisis with pulmonary oedema (invasive blood pressure 350/140mmHg). This was managed with intravenous phentolamine. Ondansetron and metoclopramide were given for intractable vomiting. A pheochromocytoma was subsequently confirmed and surgically excised. Our experience in this case generated several important learning points that we hope may be of benefit to others who encounter suspected pheochromocytomas on the acute medical take.

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Viewpoint: Management of the patient with an ‘incidentally’ raised troponin

Viewpoint, Volume 10, Issue 3, Pages 121 - 172 (2011)

Abstract

Troponin assays are a valuable tool in early risk stratification of patients with ischaemic sounding chest pain. However, troponin is often measured outside of this clinical context. The finding of a raised troponin value may be misinterpreted as an acute coronary syndrome leading to unnecessary and sometimes dangerous anticoagulation. This article looks at some of the considerations which need to be made when interpreting the significance of a raised troponin value.

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Exercise Stress Test Utility in Patients with Chest Pain Presumed to be of Cardiac Origin

Research Audit and Clinical Practice, Volume 12, Issue 3, Pages 125 - 184 (2013)

Abstract

Introduction: NICE stated exercise stress tests (EST) should not be used to diagnose obstructive coronary artery disease in patients presenting with chest pain presumed to be of cardiac origin.

Methods: A retrospective review of 209 patients with presumed cardiac chest pain was done. EST results, GRACE scores and need for invasive coronary angiogram (ICA) were analysed to predict the need for readmission, intervention and future events.

Results: The sensitivity of the EST in identifying obstructive coronary artery disease was 70%. The EST, ICA and the GRACE 6-month mortality had a 77%, 70% and 81% negative predictive value (NPV) for readmission respectively.

Conclusion: EST, GRACE scores and ICA are useful in providing prognostic information but are poor predictors of readmission. Follow up and education programmes are needed to reduce this burden.

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