29 April 2017 : Case report
ST-Segment Elevation Myocardial Infarction with Acute Stent Thrombosis Presenting as Intractable Hiccups: An Unusual Case
Unusual clinical course, Challenging differential diagnosisFan Zhang1ABCDEF*, Nosakhare Douglas Tongo1BCDE, Victoria Hastings2BCDEF, Parisa Kanzali3BCDEF, Ziqiang Zhu1CDEF, Hal Chadow4BCD, Shahrokh E. Rafii4ABCDEFG
Am J Case Rep 2017; 18:467-471
BACKGROUND: Acute coronary syndrome (ACS) can present with atypical chest pain or symptoms not attributed to heart disease, such as indigestion. Hiccups, a benign and self-limited condition, can become persistent or intractable with overlooked underlying etiology. There are various causes of protracted hiccups, including metabolic abnormalities, psychogenic disorders, malignancy, central nervous system pathology, medications, pulmonary disorders, or gastrointestinal etiologies. It is rarely attributed to cardiac disease.
CASE REPORT: We report a case of intractable hiccups in a 51-year-old male with cocaine related myocardial infarction (MI) before and after stent placement. Coronary angiogram showed in-stent thrombosis of the initial intervention. Following thrombectomy, balloon angioplasty, and stent, the patient recovered well without additional episodes of hiccups. Although hiccups are not known to present with a predilection for a particular cause of myocardial ischemia, this case may additionally be explained by the sympathomimetic effects of cocaine, which lead to vasoconstriction of coronary arteries.
CONCLUSIONS: Hiccups associated with cardiac enzyme elevation and EKG ST-segment elevation before and after percutaneous coronary intervention (PCI) maybe a manifestation of acute MI with or without stent. The fact that this patient was a cocaine user may have contributed to the unique presentation.
Keywords: Cocaine, Coronary Thrombosis, Hiccup, Myocardial Infarction, percutaneous coronary intervention
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