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    Home > Active Ingredient News > Digestive System Information > Severe chest pain, pseudo-Wellens syndrome, acute pancreatitis or coronary heart disease?

    Severe chest pain, pseudo-Wellens syndrome, acute pancreatitis or coronary heart disease?

    • Last Update: 2020-06-23
    • Source: Internet
    • Author: User
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    Chest pain is not a simple coronary heart disease caused by angina, but may also be the cause of these diseaseswe discuss edited the following cases:male, 45, who was admitted to hospital with "sustained chest pain for 36 hours"36 hours ago appeared left breast pain, radiation to the left shoulder back and left upper arm, accompanied by abdominal pain, nausea, breathing difficulties discomfort, denied palpitations, fainting, sitting breathing, night time bursts of breathing difficulties, double swelling, denial of sweating, vomiting discomfort, so emergency visitsThere has a history of alcohol consumption and smoking, no history of hypertension, hyperlipidemia,diabetes,no history of taking drugsAge-appropriate marriage, have 1 childThe mother has diabetes and has no family historyemergency department:patient's acute facial, expression pain, blood pressure: 156/101mmHg, heart rate: 75 times/ min, breathing: 20 times/min, body temperature: 36.8 c BMI, 25.5kg/m2, no neck veins and anger, unheard and cervical artery and heart mury, rest of the abnormallaboratory examination:Tn I 0.03 ng/ml (0.00-0.03), BNP 59pg/ml (0-99), lipase 246U/L (13-51), amylase 475U/L (28-100), white blood cell 7.1 x 10/l (4-10 x 109), hemoglobin 140.0g/l (120-160), platelet 167 x 109/l (100-300 x 109), sodium 136mmol/l (136-145), blood potassium 3.1mol/l (3.5-5.5)Auxiliary Check:Electrocardiogram (Figure 1a): Sinus heart rate, V1-V3 conductor ST segment elevation, T-wave inversionReview the electrocardiogram again after 40 minutes (Figure 1b): there is a sustained ST segment increase, the T-wave dynamic change (V1-V3 conductor T-wave is symmetrically deep inversion) Heart color super: the heart structure did not show abnormal, room interval thickness of 10mm, left chamber back wall 9 mm, myocardial heart did not see sectional movement abnormality, blood score 61% However, due to persistent chest pain and dynamic changes in the electrocardiogram, considering the left frontal stenosis of the coronary artery, which meets the criteria of the wellens syndrome diagnosis , and immediately performs coronary artery angiography Wellens syndrome is characterized by a history of chest pain attacks, and electrocardiograms have characteristic changes and evolutions, V2 to V3 (even V1 to V5 guide) lead ST segmentin in isopotential line or mild elevation (0.1 mV); The patient's coronary artery angiography showed that the coronary artery was normal, but the dominant right coronary artery (RCA) originated from an abnormality in the opposite sinuses (Figure 2) Figure 2 began to treat the pain management of intravenous infusion serolipase (246 to 346U/L) due to elevated levels of serum lipase (246 to 346U/L) Within 24 hours of admission, chest pain disappeared, electrocardiogram no dynamic change, no change in hypokalemia For the next 24 to 36 hours, the upper abdominal pain discomfort was basically alleviated Coronary artery computertomizing vascular angiography (CTA) shows no coronary artery calcification or coronary atherosclerosis changes in the coronary artery and pulmonary artery (Figure 3) Before being discharged from the hospital, he did a exercise tablet test for cardiomyosinion imaging, and he exercised for 10:04 minutes under the regular Bruce program (99% predicted the maximum heart rate), his blood pressure was normal, and the electrocardiogram did not change No signs of myocardial ischemia were seen in the cardiomyopathy perfusion image concurrent chest and upper abdominal pain, especially in patients whose electrocardiogram changes suggest myocardial ischemia or infarction, may be challenging for diagnosis The patient showed chest pain and dynamic electrocardiogram changes, similar to severe stenosis of the LAD coronary artery, accompanied by upper abdominal pain, elevated levels of amylase and lipase, and hypokalemia Patientchest pain is associated with unstable angina, and dynamic electrocardiogram changes are consistent with Wellens syndrome Therefore, although his troponin levels were measured within the normal range in the emergency department and central laboratory, and during chest pain, he tested the bedside by chest echocardiogram for no abnormal ventricular movement, but a invasive approach was taken except FOR LAD coronary artery stenosis Figure 3 when chest pain was relieved, the eicardiogram returned to normal, and his initial electrocardiogram changes were attributed to hypokalemia caused by acute alcoholic pancreatitis More than half of patients with acute pancreatitis experienced acute electrocardiogram changes, ranging from ST segments and T-wave changes to ventricular conduction abnormalities The potential mechanism of change in electrocardiogram of acute pancreatitis is not clear, and is speculated to be related to the following mechanisms: (1) inflammatory oozing into the peritonaina stimulates the abdominal cavity, reflecting causes a wide range of blood vessels (including coronary artery) spasms, leading to blood vessel thrombosis formation caused by myocardial ischemia and infarction; (3) May be related to the production of too much catecholamine, because pain can make sympathetic nerve excitatory, catecholamine production too much, causing coronary artery spasms; Conclusion if angina and acute pancreatitis patients have normal myocardial enzymes and elevated levels of lipase and amylase, clinicians may consider postponing immediate cardiac catheterization and attributing the change in electrocardiogram to acute pancreatitis However, when clinical signs and electrocardiogram results are highly indicative of myocardial ischemia/injury, the immediate absence of coronary arterial CT angiogramanography may be the best early diagnosis Little Cute Source: The Voice of Medicine
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