Saleh Juman Alseiari Saleh, Fadil Ali Al Thehli Reem, Farooq Munawar
Department of Emergency Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, ARE.
Department of Internal Medicine, Emergency Medicine Section, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, ARE.
Cureus. 2023 Jun 8;15(6):e40161. doi: 10.7759/cureus.40161. eCollection 2023 Jun.
Acute coronary syndrome (ACS) is common in people with chronic kidney disease (CKD) and is linked to poor short- and long-term outcomes. The diagnosis of myocardial infarction is challenging in patients with CKD as they have baseline elevated troponin levels. To date, there are no widely accepted guidelines to suggest what is a clinically significant change in troponin levels in these patients. We report a case of a patient with CKD who presented with chest pain to the emergency department (ED). His baseline troponin was high; however, the delta change was 11%. He was discharged from the ED for outpatient follow-up, but within 36 hours, he had significant ST elevation myocardial infarction (STEMI) with unstable hemodynamics and acute heart failure requiring urgent intubation and coronary revascularization. This case highlights the gap in clinical knowledge and practice in a relatively not uncommon presentation in emergency departments.
急性冠状动脉综合征（ACS）在慢性肾脏病（CKD）患者中很常见，并且与短期和长期预后不良有关。由于CKD患者肌钙蛋白水平基线升高，因此心肌梗死的诊断具有挑战性。迄今为止，尚无广泛接受的指南来表明这些患者肌钙蛋白水平的何种变化具有临床意义。我们报告一例CKD患者，该患者因胸痛就诊于急诊科（ED）。其肌钙蛋白基线水平较高；然而，变化差值为11%。他从急诊科出院进行门诊随访，但在36小时内，他发生了严重的ST段抬高型心肌梗死（STEMI），伴有血流动力学不稳定和急性心力衰竭，需要紧急插管和冠状动脉血运重建。该病例凸显了急诊科相对常见的一种临床表现中临床知识和实践方面的差距。
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