What can mimic a MI?

[SuperC]

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Hx: Pacemaker and coumadin
Sx: Symptoms similar to MI. Radiating pain, chest arm and hand. General fatigue

Labs for Troponin I and troponin T, CPK and CPK-MB, and Serum myoglobin all WNL.

What could this be? I am at a loss... My best guess = Pericarditis from some sort of viral infection, but I do not have any WBC counts.

Any Ideas would be appreciated.
-C

 

[smq123]

Hx: Pacemaker and coumadin
Sx: Symptoms similar to MI. Radiating pain, chest arm and hand. General fatigue

Labs for Troponin I and troponin T, CPK and CPK-MB, and Serum myoglobin all WNL.

What could this be? I am at a loss... My best guess = Pericarditis from some sort of viral infection, but I do not have any WBC counts.

• How many negative troponins have come back? Have there been three negative ones? Without three, they're not really "ruled out" yet.
• Any pleuritic chest pain? Was a D-dimer done? Any acute SOB?
• CXR? Any signs of aortic dissection?
• Does leaning forward make the pain feel better? That could indicate pericarditis. What was heard with chest auscultation?
• Any distended neck veins?
• How long have symptoms been going on? Anything interesting on EKG?
• How long have they been on coumadin? What's the INR?

I really hope you're asking for a school project or for your personal curiosity...and not because someone that you know is currently experiencing such chest pain.... Because if so, that person needs to get to an ER right away!

 

[SuperC]

• How many negative troponins have come back? Have there been three negative ones? Without three, they're not really "ruled out" yet.
• Any pleuritic chest pain? Was a D-dimer done? Any acute SOB?
• CXR? Any signs of aortic dissection?
• Does leaning forward make the pain feel better? That could indicate pericarditis. What was heard with chest auscultation?
• Any distended neck veins?
• How long have symptoms been going on? Anything interesting on EKG?
• How long have they been on coumadin? What's the INR?

I really hope you're asking for a school project or for your personal curiosity...and not because someone that you know is currently experiencing such chest pain.... Because if so, that person needs to get to an ER right away!

Just for school!!! It was just in some of my reading and I could not put a finger on it... I will run this past the profs for some more help.
-C

 

[aphistis]

Clinical symptoms of MI lasting more than 20 minutes, in conjunction with specific EKG changes (e.g. pathologic ST elevation in multiple contiguous leads) is enough to diagnose ACS even if cardiac markers come back negative (they are poorly sensitive during the first six hours of an MI).

Source: http://www.merck.com/mmpe/sec07/ch073/ch073c.html

 

[BuckeyMcGee]

Refer patient to the physician, this is beyond the scope of most dentists' practices. Theoretically a lot could mimic a MI...😉

 

[SuperC]

TORN ROTATOR CUFF!!!!!!!!!!!!!!!!!!!! Sigh....
-C

 

[1992Corolla]

LOL, only in dental school. Nice case report C.