Why the study?
Identification of patients with ACS can be challenging, especially among women, and its clinical presentation can often overlap with other medical entities.
A giant hiatal hernia can compress cardiac structures and mimic the clinical and electrocardiographic presentation of an ST-elevation myocardial infarction.
Exercise-induced ST elevation in women with asthma may signal ACS mimicry; leaves open need for prospective validation of diagnostic thresholds.
BACKGROUND: Acute coronary syndrome (ACS) can be a life-threatening condition. However, identification of patients with ACS can be challenging, especially among women, and clinical presentation can often overlap with other medical entities. CASE SUMMARY: A 61-year-old woman with a history of stable bronchial asthma presented with worsening dyspnoea for spiroergometry. During bicycle exercise testing, she developed acute chest pain and her electrocardiogram showed significant ST-segment elevations. High-sensitivity cardiac troponin was elevated and a coronary angiography was performed showing normal coronary arteries. Cardiac magnetic resonance imaging showed no signs of myocardial infarction, myocarditis or Takotsubo cardiomyopathy but the incidental finding of a giant hiatal hernia impeding the filling of the left atrium. The giant hernia was surgically corrected, and the patient's exertional dyspnoea fully relieved during follow-up. DISCUSSION: Hiatal hernia might compress cardiac structures, cause exertional dyspnoea and mimic ST-elevation myocardial infarction. 10.1093/ehjcr/ytz138_audio1 ytz138_audio1 6074443146001.
No takes yet. Share an insight, caveat, or question.
Giménez et al. (2019) studied this question.
Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context: