Key result
Acute urinary retention presents as painless STEMI with 100% RCA occlusion.
Why the study?
STEMI can present without chest pain in 10-13% of patients, leading to delayed diagnosis and worse outcomes.
Case Report (n=1)
This case highlights the diagnostic value of prehospital ECG in patients with non-cardiac complaints and emphasizes that objective evidence of ischemia must be pursued even when an alternative source of pain is identified and treated.
ST-segment elevation myocardial infarction (STEMI) classically presents with chest pain, yet 10-13% of patients present without it, leading to delayed diagnosis and worse outcomes. We report a 59-year-old man with prostate cancer who presented to the emergency department (ED) via emergency medical services (EMS) with acute penile and suprapubic pain from urinary retention. He denied chest pain, dyspnea, and other cardiac symptoms throughout his encounter. A prehospital 12‑lead electrocardiogram (ECG) revealed ST-segment elevations in leads II, III, and aVF, prompting a STEMI alert. In the ED, bladder ultrasonography confirmed distention, and Foley catheter placement resolved his obstruction and pain. Despite complete symptom resolution, persistent ST elevation prompted emergent catheterization, which revealed 100% occlusion of the right coronary artery (RCA). This case illustrates painless STEMI, the diagnostic value of prehospital ECG in patients with non-cardiac complaints, and the principle that persistent objective evidence of ischemia must not be dismissed when an alternative pain source is treated.
No takes yet. Share an insight, caveat, or question.
Carter et al. (2026) conducted a case report in Painless ST-segment elevation myocardial infarction (STEMI) with acute urinary retention (n=1). Prehospital ECG and emergent cardiac catheterization was evaluated. A 59-year-old man presenting with acute urinary retention and no chest pain was diagnosed with a STEMI showing 100% right coronary artery occlusion on emergent catheterization.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: