A 66-Year-Old Woman with Intermittent Chest Pain and Dyspnea Who Underwent Continued ST-Segment Monitoring to Identify Occult ST-Segment Elevation that Expedited Coronary Angiography and Revascularization

Patient: Female, 66-year-old Final Diagnosis: Coronary artery disease Symptoms: Chest discomfort Medication:— Clinical Procedure: Coronary angiography • percutaneous coronary intervention Specialty: Cardiology OBJECTIVE: Challenging differential diagnosis BACKGROUND: In patients admitted to the hospital owing to suspected acute coronary syndrome and where the first electrocardiogram (ECG) is non-diagnostic of ST-elevated myocardial infarction (STEMI), international guidelines recommend that sequential ECGs are performed to identify new or intermittent ST-deviations. Continued monitoring for ST-segment alterations is rarely performed, in contrast to the continued monitoring for arrhythmias. Continued monitoring for ST-segment alteration may detect intermittent ST-segment elevations not captured by routine 12-lead ECGs. We present a case in which continued ST-segment monitoring revealed intermittent ST-segment elevations and led to expedited coronary angiography and revascularization. CASE REPORT: A 66-year-old woman was admitted to a regional hospital in Denmark with intermittent retrosternal chest pain and dyspnea. Her risk profile included a family history of cardiovascular disease, hypercholesterolemia, active smoking, and obesity. The results of 3 sets of high-sensitivity cardiac troponins and sequential 12-lead ECG measurements were normal. Because of clinical suspicion of unstable angina, the patient remained admitted. Continued rhythm and ST-segment monitoring was initiated. During continued ST-segment monitoring, asymptomatic intermittent ST-elevations in the inferior leads were detected. The patient was referred for an acute coronary angiography at the nearest cardiac center. Coronary catheterization showed right coronary artery stenosis, and complete revascularization was obtained by percutaneous coronary intervention with stent implantation. CONCLUSIONS: Continued ST-segment monitoring can detect intermittent ST-segment elevations and thereby substantiate the need for acute coronary angiography.