Davor Horvat
General Hospital Karlovac, CroatiaPresentation Title:
Diagnostic problem in acute myocardial infarction and vasospastic angina pectoris
Abstract
The aim of this case report is to show ST elevation in the electrocardiogram (ECG) as a differential diagnostic problem between acute myocardial infarction and vasospastic angina pectoris. A 79-year-old patient comes to the hospital because of chest pain. ECG shows inferioris and anterolateralis ST elevation. He was referred to the percutaneous coronary intervention (PCI) network. After emergency coronary angiography, all three epicardial coronary arteries were shown without hemodynamically significant stenoses. Echocardiography showed akinesia of the distal septum, anterior wall and apex with consequent ejection fraction of the left ventricle from 40%. After three days of hospitalization the 24 hour ECG showed transient ST elevation in all three leads, which corresponds to the inferior and anterolateral region in the 12-channel ECG. This transitory event was not accompanied by significant angina pectoris pains or an increase in troponin. The most common differential diagnosis of ST elevation in the ECG is acute myocardial infarction, but possible Prinzmetal's angina with or without myocardial infarction should also be considered.
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