Bilal Muhammad, Malik Muhammad H, Ansari Ali Z, Bahro Ghazwan, Jaiswal Abhishek
Department of Internal Medicine, Merit Health Wesley, Hattiesburg, USA.
Department of Pathology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA.
Cureus. 2024 Jul 17;16(7):e64746. doi: 10.7759/cureus.64746. eCollection 2024 Jul.
Chest pain is a common and complex symptom that can arise from various etiologies, ranging from benign musculoskeletal conditions to life-threatening cardiovascular events. It is a hallmark symptom of myocardial infarction, angina, and other ischemic heart diseases, necessitating prompt and thorough evaluation. Ongoing chest pain post-procedures and medication administration presents a diagnostic challenge, as it may be indicative of an exacerbation of underlying conditions. We present the case of a 64-year-old Caucasian male who initially presented with severe and persistent chest pain suggestive of an anterior wall ST-elevation myocardial infarction (STEMI). He had a history of coronary artery disease and had recently undergone cardiac catheterization. Despite prompt administration of nitroglycerin and aspirin, the patient's symptoms persisted, prompting emergent percutaneous coronary intervention (PCI). Subsequent to PCI, ongoing chest discomfort persisted, prompting further investigation, which revealed a concurrent lung mass and nodules on imaging. Additional interventions, including repeated PCI procedures and thoracentesis, were undertaken. Unfortunately, the patient's clinical course rapidly deteriorated, culminating in cardiac arrest and unsuccessful resuscitative efforts. This case highlights the complexities inherent in managing intricate cardiovascular conditions and emphasizes the critical importance of maintaining vigilance for concomitant pathologies.
胸痛是一种常见且复杂的症状,可由多种病因引起,从良性肌肉骨骼疾病到危及生命的心血管事件不等。它是心肌梗死、心绞痛及其他缺血性心脏病的标志性症状,需要迅速且全面的评估。术后及用药后持续存在的胸痛带来了诊断挑战,因为它可能表明潜在病情加重。我们报告一例64岁的白种男性病例,该患者最初表现为严重且持续的胸痛,提示前壁ST段抬高型心肌梗死(STEMI)。他有冠状动脉疾病史,近期接受了心脏导管插入术。尽管迅速给予了硝酸甘油和阿司匹林,但患者症状持续,促使紧急进行经皮冠状动脉介入治疗(PCI)。PCI术后,持续的胸部不适依然存在,促使进一步检查,影像学检查发现同时存在肺部肿块和结节。采取了包括重复PCI手术和胸腔穿刺术在内的其他干预措施。不幸的是,患者的临床病程迅速恶化,最终导致心脏骤停且复苏努力失败。该病例凸显了处理复杂心血管疾病所固有的复杂性,并强调了对伴随病变保持警惕的至关重要性。