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Abdominal and Pelvic Computed Tomography for the Diagnosis of ST-Elevation Myocardial Infarction: The Challenges of Acute Coronary Syndrome in Diabetic Patients
Diabetes mellitus (DM) is a major independent risk factor for cardiovascular disease. Patients who present with the metabolic emergency of diabetic ketoacidosis (DKA) have similar symptoms of diaphoresis, nausea, emesis, and abdominal pain, which can conceal acute coronary syndrome (ACS). We present...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cureus
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9701564/ https://www.ncbi.nlm.nih.gov/pubmed/36451633 http://dx.doi.org/10.7759/cureus.30816 |
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author | Briggs, Blake Zitelny, Edan Zitelny, Tamir |
author_facet | Briggs, Blake Zitelny, Edan Zitelny, Tamir |
author_sort | Briggs, Blake |
collection | PubMed |
description | Diabetes mellitus (DM) is a major independent risk factor for cardiovascular disease. Patients who present with the metabolic emergency of diabetic ketoacidosis (DKA) have similar symptoms of diaphoresis, nausea, emesis, and abdominal pain, which can conceal acute coronary syndrome (ACS). We present a unique case where computed tomography (CT) of the abdomen and pelvis with IV contrast played an integral role in diagnosing an acute myocardial infarction in a patient with no typical ischemic symptoms. A 56-year-old female presented to the emergency department with abdominal pain, nausea, and vomiting. She was suspected of having DKA. Aggressive management was started, including weight-based appropriate IV regular insulin. A CT abdomen and pelvis with IV contrast was performed due to persistent abdomen pain. This demonstrated severe hypoattenuation of the posteroinferior aspect of the left ventricular wall. An EKG was immediately performed and was consistent with an inferior STEMI. The patient was taken to the interventional cardiology suite where they found the culprit lesion to be mid-circumflex with 100% stenosis. This case highlights many important lessons in approaching diabetic patients who are presenting with DKA. DM is associated with cardiac autonomic neuropathy (CAN), a condition that greatly influences perceived chest pain. While little is known about this condition, some manifestations include resting tachycardia, exercise intolerance, orthostatic hypotension, and an increased risk of silent myocardial infarction. Critically, providers must maintain a low threshold to assess for cardiac ischemia in diabetic patients and more readily obtain EKGs in triage as well as during the patient’s course in the ED to prevent complications from delayed ACS care. |
format | Online Article Text |
id | pubmed-9701564 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Cureus |
record_format | MEDLINE/PubMed |
spelling | pubmed-97015642022-11-29 Abdominal and Pelvic Computed Tomography for the Diagnosis of ST-Elevation Myocardial Infarction: The Challenges of Acute Coronary Syndrome in Diabetic Patients Briggs, Blake Zitelny, Edan Zitelny, Tamir Cureus Cardiology Diabetes mellitus (DM) is a major independent risk factor for cardiovascular disease. Patients who present with the metabolic emergency of diabetic ketoacidosis (DKA) have similar symptoms of diaphoresis, nausea, emesis, and abdominal pain, which can conceal acute coronary syndrome (ACS). We present a unique case where computed tomography (CT) of the abdomen and pelvis with IV contrast played an integral role in diagnosing an acute myocardial infarction in a patient with no typical ischemic symptoms. A 56-year-old female presented to the emergency department with abdominal pain, nausea, and vomiting. She was suspected of having DKA. Aggressive management was started, including weight-based appropriate IV regular insulin. A CT abdomen and pelvis with IV contrast was performed due to persistent abdomen pain. This demonstrated severe hypoattenuation of the posteroinferior aspect of the left ventricular wall. An EKG was immediately performed and was consistent with an inferior STEMI. The patient was taken to the interventional cardiology suite where they found the culprit lesion to be mid-circumflex with 100% stenosis. This case highlights many important lessons in approaching diabetic patients who are presenting with DKA. DM is associated with cardiac autonomic neuropathy (CAN), a condition that greatly influences perceived chest pain. While little is known about this condition, some manifestations include resting tachycardia, exercise intolerance, orthostatic hypotension, and an increased risk of silent myocardial infarction. Critically, providers must maintain a low threshold to assess for cardiac ischemia in diabetic patients and more readily obtain EKGs in triage as well as during the patient’s course in the ED to prevent complications from delayed ACS care. Cureus 2022-10-28 /pmc/articles/PMC9701564/ /pubmed/36451633 http://dx.doi.org/10.7759/cureus.30816 Text en Copyright © 2022, Briggs et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Cardiology Briggs, Blake Zitelny, Edan Zitelny, Tamir Abdominal and Pelvic Computed Tomography for the Diagnosis of ST-Elevation Myocardial Infarction: The Challenges of Acute Coronary Syndrome in Diabetic Patients |
title | Abdominal and Pelvic Computed Tomography for the Diagnosis of ST-Elevation Myocardial Infarction: The Challenges of Acute Coronary Syndrome in Diabetic Patients |
title_full | Abdominal and Pelvic Computed Tomography for the Diagnosis of ST-Elevation Myocardial Infarction: The Challenges of Acute Coronary Syndrome in Diabetic Patients |
title_fullStr | Abdominal and Pelvic Computed Tomography for the Diagnosis of ST-Elevation Myocardial Infarction: The Challenges of Acute Coronary Syndrome in Diabetic Patients |
title_full_unstemmed | Abdominal and Pelvic Computed Tomography for the Diagnosis of ST-Elevation Myocardial Infarction: The Challenges of Acute Coronary Syndrome in Diabetic Patients |
title_short | Abdominal and Pelvic Computed Tomography for the Diagnosis of ST-Elevation Myocardial Infarction: The Challenges of Acute Coronary Syndrome in Diabetic Patients |
title_sort | abdominal and pelvic computed tomography for the diagnosis of st-elevation myocardial infarction: the challenges of acute coronary syndrome in diabetic patients |
topic | Cardiology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9701564/ https://www.ncbi.nlm.nih.gov/pubmed/36451633 http://dx.doi.org/10.7759/cureus.30816 |
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