Key result
A 31-year-old man presenting with syncope and total AV block without chest pain or ischemic ECG changes was successfully diagnosed with NSTEMI and treated with an early invasive strategy.
Why the study?
Atypical or asymptomatic ACS presentation is associated with a poor prognosis, motivating characterization of clinical features and management in patients presenting without chest pain and with non-ischemic ECG.
Case Report (n=1)
Atypical presentation of acute coronary syndrome as complete heart block without chest pain or ischemic ECG changes in a young adult highlights the need for high clinical suspicion and cardiac enzyme testing in patients with risk factors.
Supports prompt ACS evaluation in atypical heart block; single case report leaves open broader applicability.
Background: The majority of studies indicate that the asymptomatic or atypical presentation of acute coronary syndrome (ACS) as a significant manifestation of coronary artery disease (CAD) is associated with a poor prognosis. The purpose of this study was to characterize the clinical characteristics and management of ACS patients who presented without chest pain and non-ischemic electrocardiogram (ECG). Case Illustration: A 31 years old man with syncope was brought to our hospital. ECG revealed total AV block (TAVB) without ST segment changes. First, he was diagnosed with cardiac syncope because his ECG showed no ischemic sign. He had a strong familial history of CAD, so we examined his cardiac enzymes and found an increase in serial cardiac enzymes. Then, he was diagnosed with non-ST elevation myocardial infarction (NSTEMI). Early invasive strategy with chronic total occlusion (CTO) at osteal right coronary artery (RCA) and acute total occlusion at mid RCA with implantation of 1 DES at osteal-proximal RCA was selected for this patient. After five days of hospitalization, he discharged home with medicines. Conclusion: In order to significantly lower their morbidity and mortality, this group of high-risk patients needs to receive improved early diagnostic and treatment choices.
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Suprayoga et al. (2023) conducted a case report in Acute Coronary Syndrome (NSTEMI) with complete heart block (n=1). Early invasive strategy with DES implantation was evaluated. A 31-year-old man presenting with syncope and total AV block without chest pain or ischemic ECG changes was successfully diagnosed with NSTEMI and treated with an early invasive strategy.
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