Key result
Standing position provokes acute ischemic ECG changes in a single male patient.
Why the study?
Acute coronary syndrome and myocardial infarction can present with atypical symptoms, but this rarely includes middle-aged males without underlying medical conditions.
Case Report (n=1)
Highlights a rare presentation of acute coronary ischemia where diagnostic ECG changes were only visible when the patient was standing.
Atypical ACS presentations may occur even in middle-aged men without comorbidities; leaves open whether chronic back pain warrants expanded prehospital ECG criteria.
Acute coronary syndrome and myocardial infarction have been described to present with atypical symptoms in certain subsets of patients. However, these subsets commonly do not include middle-aged males with a paucity of underlying medical conditions. We present a very unique case of acute coronary syndrome in a 53-year-old male, with no previously identified medical conditions other than chronic back pain. The patient was encountered by rural emergency medical service providers presenting with syncope followed by intermittent episodes of lightheadedness. Further, electrocardiographic changes consistent with acute ischemia could only be demonstrated with the patient in a standing position, prior to the development of an occurrence of ventricular tachycardia, which degenerated into ventricular fibrillation. To our knowledge, this is a very rare case of electrocardiographic changes consistent with occult, acute cardiac ischemia with a proven coronary artery lesion seen initially only with the patient in a standing position.
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Ross et al. (2014) conducted a case report in Acute coronary syndrome (n=1). Standing position was evaluated on Electrocardiographic changes consistent with acute ischemia. Electrocardiographic changes consistent with acute cardiac ischemia were demonstrated in a 53-year-old male only while in a standing position.
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