A patient suffers from acute attacks of chest pain, which is relieved by IV analgesics. Please help.

Question

Hi doctor,

The patient's age is 40 years. She is a housewife, and a mother of four children, with a good socio-economic status. The patient suffered from severe chest pain radiating towards the left shoulder and neck, sudden in onset, severe in intensity, and burning in nature. There were three episodes of an acute attack of pain. Each time pain was relieved by IV analgesics. The pain was associated with high blood pressure 220/160 mmHg during the first episode, and there is nausea but no vomiting or headache. There is no previous history of such attacks in the past. The patient gave a history of hypertension on and off for which she was taking medicine with poor compliance. The history of analgesics (Paracetamol) intake for the past few years for generalized body aches and mild joint pain and mild pain in the chest for the past six months. There is no family history of HTN and IHD. Management with IV analgesics was given during pain episodes; ECG repeated two times, which was normal cardiac markers were done after 24 hours of the third episode of pain. Troponin was positive. The cardiologist advised the cardiac stress test, the report, which is still awaited. Furthermore, he assured that the cardiac issue's chances are low due to age factors and negative family history. I want a brief point of view regarding this patient from any cardiologist. They depended upon the history of ECG and cardiac markers.

Answer 1

Hi,

Welcome to icliniq.com.

Thanks for the query. Suppose if the patient had typical chest pain and cardiac troponin was positive. In that case, this strongly suggests myocardial infarction except in few issues such as chronic kidney disease, heart failure, and sepsis, etc. in which troponins are chronically mildly elevated. Serial troponin levels are done to see either rising or falling pattern of enzymes; if stable over several samples, this suggests chronic elevation due to myocardial injury as in the case of CKD (chronic kidney disease), sepsis, etc. Another possibility is aborted myocardial infarction in which ECG (electrcardiography) changes reverted, the pain subsided, but cardiac enzymes remain elevated for a few days in a falling trend. Another possibility is Prinzmetal angina that is due to the vasospasm of coronary arteries. Serial troponins should have been done, serial ECGs, and bedside echocardiography. If other baseline tests are normal, then coronary angiography should be done in this case within 24 hours.