Document Detail

Pancreatic cholangiocarcinoma as an ST-elevation myocardial infarction with thrombolytic therapy.
MedLine Citation:
PMID:  20223412     Owner:  NLM     Status:  MEDLINE    
We report the case of a 46-year-old patient who presented a chest pain with ST-segment elevation in precordial leads V1 (2 mm), V2 (4 mm), and V3 (3 mm). Thrombolytic therapy was initiated with the combination tenecteplase tissue plasminogene activator, aspirin, and heparin. Further electrocardiogram and cardiac enzymes measured every 2 hours during the first 24 hours remained normal, and after a computed tomography of the abdomen, the patient was taken to surgery for an exploratory abdominal operation that revealed pancreatic cholangiocarcinoma. No adverse effects were attributed to the initial thrombolytic therapy. Finally, myocardial ischemia was excluded because the electrocardiogram, cardiac enzymes, and a 1-month later cardiac stress test remained normal and because no coronary event occurred during the first year after surgery. Our case shows that it is sometimes difficult to make the share, in prehospital field, between coronary syndrome and other pathology, particularly digestive pathology. However, in the appropriate chest pain patient with presumed acute myocardial infarction, ST-segment elevation remains the primary criterion for the initiation of thrombolytic therapy, primary angioplasty, and/or other pharmacologic interventions.
Baptiste Vallé; Philippe Frontin; Vincent Bounes; Sandrine Charpentier; Charpentier Sandrine; Vincent Minville; Jean-Louis Ducassé; Ducassé Jean-Louis
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The American journal of emergency medicine     Volume:  28     ISSN:  1532-8171     ISO Abbreviation:  Am J Emerg Med     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-12     Completed Date:  2010-05-06     Revised Date:  2010-10-12    
Medline Journal Info:
Nlm Unique ID:  8309942     Medline TA:  Am J Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  389.e3-5     Citation Subset:  IM    
SAMU, Pôle de Medecine d'Urgence, Hôpitaux Universitaires, Toulouse, France.
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MeSH Terms
Chest Pain / drug therapy,  radiography
Cholangiocarcinoma / radiography*,  surgery
Diagnosis, Differential
Middle Aged
Myocardial Infarction / diagnosis,  drug therapy
Pancreatic Neoplasms / radiography*,  surgery
Thrombolytic Therapy
Tomography, X-Ray Computed
Erratum In:
Am J Emerg Med. 2010 Oct;28(8):980
Note: Sandrine, Charpentier [corrected to Charpentier, Sandrine];Jean-Louis, Ducassé [corrected to Ducassé, Jean-Louis]

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