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Unusual Pharyngeal Pain Caused by Acute Coronary Syndrome: A Report of Three Cases

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ABSTRACT

Most patients complaining of pharyngeal pain have an upper respiratory tract infection or other local explanation for their pain. Here we show 3 rare cases of patients visiting our Otorhinolaryngology Department who had an initial symptom of pharyngeal pain caused by acute coronary syndrome (ACS). An electrocardiogram and a cardiac biomarker test are recommended to exclude ACS with atypical presentation in cases without pharyngolaryngeal findings comparable to pharyngeal pain.

No MeSH data available.


The electrocardiogram showed ST segment elevation in V1-V5.
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fig002: The electrocardiogram showed ST segment elevation in V1-V5.

Mentions: A 72-year-old woman presented to the ENT department of our hospital with a 5-day history of sore throat. There were no other symptoms of an upper respiratory tract infection. She and her family had no cardiovascular disease history. She took no regular medication and had no allergies. She was a nonsmoker and did not consume alcohol. She had no other cardiac risk factors. On examination, she was 138 cm in height and 45 kg in weight with a body mass index of 23.6. She seemed not to be in distress. She only complained of a moderate sore throat, which she had never had before. She has no tenderness on her neck or swallowing pain. She denied chest pain, shortness of breath, or nausea. Her body temperature was 95 F. Her heart rate was 70 bpm, regular and her blood pressure was 122/64 mmHg. Her oxygen saturation was 98% on room air .She had an inflamed tonsil. On the laryngeal fiberscope test, she had no swelling or inflamed pharyngolarynx mucosa (Figure 1). She had no cervical lymphadenopathy. Her lungs were clear on auscultation and her heart sounds were dual with no murmur. The lab data showed that WBC was 10,700/µL (neutrophil=81.8%), CRP was under 0.03 and other data were normal. Because there was no symptom apart from a sore throat, we could not make an initial diagnosis. Nine hours after the initial examination, she said to a nurse that she had a severely stiff shoulder. Finally, she suffered from severe back pain and chest pain with nausea and cold sweats 16 hours after she came to our examination room. The symptoms strongly suggested acute myocardial infarction. An ECG and cardiac biomarker rapid check (troponin T and H-FABP) were ordered. The ECG showed ST-segment elevation in V1-V5 (Figure 2). Blood tests showed elevated cardiac enzymes. An echocardiography showed hypo kinesis of the anteroseptal wall. A diagnosis of AMI was made based on the elevated cardiac enzymes combined with the ECG changes and the echogram. Cardiac catheterization and angiography (CAG) were performed by a cardiologist. The CAG showed that the left anterior descending coronary artery was completely occluded and the right coronary artery and left circumflex coronary artery were 90% occluded (arrows head in Figure 3A). The left anterior descending coronary artery lesion was opened successfully with the placement of a drug-eluting stent (Figure 3B). Following this, the throat pain was improved.


Unusual Pharyngeal Pain Caused by Acute Coronary Syndrome: A Report of Three Cases
The electrocardiogram showed ST segment elevation in V1-V5.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5304265&req=5

fig002: The electrocardiogram showed ST segment elevation in V1-V5.
Mentions: A 72-year-old woman presented to the ENT department of our hospital with a 5-day history of sore throat. There were no other symptoms of an upper respiratory tract infection. She and her family had no cardiovascular disease history. She took no regular medication and had no allergies. She was a nonsmoker and did not consume alcohol. She had no other cardiac risk factors. On examination, she was 138 cm in height and 45 kg in weight with a body mass index of 23.6. She seemed not to be in distress. She only complained of a moderate sore throat, which she had never had before. She has no tenderness on her neck or swallowing pain. She denied chest pain, shortness of breath, or nausea. Her body temperature was 95 F. Her heart rate was 70 bpm, regular and her blood pressure was 122/64 mmHg. Her oxygen saturation was 98% on room air .She had an inflamed tonsil. On the laryngeal fiberscope test, she had no swelling or inflamed pharyngolarynx mucosa (Figure 1). She had no cervical lymphadenopathy. Her lungs were clear on auscultation and her heart sounds were dual with no murmur. The lab data showed that WBC was 10,700/µL (neutrophil=81.8%), CRP was under 0.03 and other data were normal. Because there was no symptom apart from a sore throat, we could not make an initial diagnosis. Nine hours after the initial examination, she said to a nurse that she had a severely stiff shoulder. Finally, she suffered from severe back pain and chest pain with nausea and cold sweats 16 hours after she came to our examination room. The symptoms strongly suggested acute myocardial infarction. An ECG and cardiac biomarker rapid check (troponin T and H-FABP) were ordered. The ECG showed ST-segment elevation in V1-V5 (Figure 2). Blood tests showed elevated cardiac enzymes. An echocardiography showed hypo kinesis of the anteroseptal wall. A diagnosis of AMI was made based on the elevated cardiac enzymes combined with the ECG changes and the echogram. Cardiac catheterization and angiography (CAG) were performed by a cardiologist. The CAG showed that the left anterior descending coronary artery was completely occluded and the right coronary artery and left circumflex coronary artery were 90% occluded (arrows head in Figure 3A). The left anterior descending coronary artery lesion was opened successfully with the placement of a drug-eluting stent (Figure 3B). Following this, the throat pain was improved.

View Article: PubMed Central - PubMed

ABSTRACT

Most patients complaining of pharyngeal pain have an upper respiratory tract infection or other local explanation for their pain. Here we show 3 rare cases of patients visiting our Otorhinolaryngology Department who had an initial symptom of pharyngeal pain caused by acute coronary syndrome (ACS). An electrocardiogram and a cardiac biomarker test are recommended to exclude ACS with atypical presentation in cases without pharyngolaryngeal findings comparable to pharyngeal pain.

No MeSH data available.