Clinical Case Database / Category: Patient Management
An ACS but not as we know it?
F Khan, S Banerjee, C Allen
Foundation Years Journal, volume 7, issue 6, p.20 (123Doc Education, London, June 2013)
The on call medical F1 was called to A&E to review a 56 year old Caucasian female presenting with chest pain. The history was of acute onset severe, central crushing chest pain, with no radiation or associated features. The pain was at its most intense for two hours, starting while at the funeral of her husband. The trigger was felt to be a poem being read by her son, which triggered an intense emotional response. The pain continued intermittently for the subsequent 24 hours but was ignored and put down to the stress of the day. She presented to her A&E the following afternoon, encouraged by
other family members.
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1. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD; the Writing Group on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction. The third universal definition of myocardial infarction. Circulation. 2012;126:2020-2035.
2. The early management of unstable angina and non-ST-segment-elevation myocardial infarction. NICE Clinical Guideline 94 (2010)
3. Pieper KS, Gore JM, FitzGerald G et al; Global Registry of Acute Coronary Events (GRACE) Investigators. Validity of a risk-prediction tool for hospital mortality: the Global Registry of Acute Coronary Events. Am Heart J. 2009;157:1097-105
4. Montalescot G, Wiviott SD, Braunwald E et al. Prasugrel compared with clopidogrel in patients undergoing purcutaneous coronary intervention for STelevation myocardial infarction (TRITONTIMI 38): double-blind, randomised controlled trial. Lancet 2009;373:723â€“731.
5. Montalescot G, Wiviott SD, Braunwald E, Murphy SA, Gibson CM, McCabe CH, Antman EM. Prasugrel compared with clopidogrel in patients undergoing purcutaneous coronary intervention for ST-elevation myocardial infarction (TRITONTIMI 38): double-blind, randomised controlled trial. Lancet 2009;373:723â€“731.
6. Yusuf S, Mehta SR, Chrolavicius S et al. Comparison of fondaparinux and enoxaparin in acute coronary syndromes. N. Engl. J. Med.354(14),1464-1476 (2006)
7. Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Guidelines on myocardial revascularization. Eur Heart J. 2010;31:2501-55.
8. Secondary prevention in primary and secondary care for patients following a myocardial infarction, NICE Clinical Guideline (2007).
9. Gianni M, Dentali F, Grandi AM, et al. Apical Ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J. 2006;27:1523â€“1529.
10. Kosuge M, Ebina T, Hibi K et al. Simple and accurate electrocardiographic criteria to differentiate takotsubo cardiomyopathy from anterior acute myocardial infarction. J Am Coll Cardiol. 2010;55:2514â€“2516.
11. NÃºÃ±ez-Gil IJ, Luaces M, Garcia-Rubira JC, et al. Electrocardiographic criteria in Takotsubo cardiomyopathy and race differences: Asians versus Caucasians. J Am Coll Cardiol. 2010;56(17):1433-4.
12. Nef HM, Mollmann H, Weber M, et al. Release pattern of cardiac biomarkers in left ventricular apical ballooning. Int J Cardiol. 2007;115:128 â€“129.
13. Elesber AA, Prasad A, Lennon RJ, et al. Four-year recurrence rate and prognosis of the Apical Ballooning syndrome. J Am Coll Cardiol. 2007;50: 448â€“452.
14. Lyon AR, Rees PS, Prasad S, et al. Stress (takotsubo) cardiomyopathyâ€”a
novel pathophysiological hypothesis to explain catecholamine-induced acute
myocardial stunning. Nat Clin Pract Cardiovasc Med. 2008;5:22â€“29.
15. Yoshioka T, Hashimoto A, Tsuchihashi K, et al. Clinical implications of
midventricular obstruction and intravenous propranolol use in transient
left ventricular apical ballooning (tako-tsubo cardiomyopathy). Am Heart J.
16. Dorfman TA, Aqel R, Mahew M, et al. Takotsubo cardiomiopathy: a review
of the literature. Curr Cardiol Rev. 2007;3:137â€“142.
17. Ueyama T, Kasamatsu K, Hano T, et al. Emotional stress induces
transient left ventricular hypocontraction in the rat via activation of cardiac
adrenoceptors: A possible animal model of â€œtako-tsuboâ€ cardiomyopathy. Circ
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About the Clinical Cases Database
The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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