Myocardial infarction or a foreign body in the airways? Case study
DOI:
https://doi.org/10.21164/pomjlifesci.1226Keywords:
foreign body, airways, obstruction, chest pain, dyspnea, STEMIAbstract
According to the European Society of Cardiology (ESC) and its 2018 IV universal definition of myocardial infarction, this pathology is not only the result of atherothrombotic coronary artery disease (CAD) but also extracardiac causes – such as type II, where the cause is a pathophysiological mechanism leading to ischemic myocardial damage in a situation of imbalance between oxygen supply and myocardial oxygen demand. As acute chest pain (ACP) is a common reason for emergency department (ED) visits, it is important to remember that it involves a wide range of both cardiovascular and non-cardiac causes. This case report describes a diagnostic challenge involving a 67-year-old patient presenting with dyspnea and acute chest pain, initially diagnosed with ST-elevation myocardial infarction (STEMI).
The patient, with a history of laryngeal cancer treated with total laryngectomy and tracheostomy, was admitted with experiencing dyspnea, chest pain, and electrocardiogram (ECG) artifacts. Imaging and clinical findings suggested moderate pulmonary congestion, while laboratory tests showed elevated troponin and d-dimer levels. An otolaryngologist (ENT) consultation revealed tracheal obstruction caused by dried blood clots, leading to periodic airway obstruction. Removing the clots significantly improved the patient’s condition.
Coronary angiography did not reveal significant coronary artery stenosis, indicate myocardial infarction as the cause of symptoms.
The clinical implications of this case include focusing the interview on tracheostomy tube care in the prehospital setting. They may also aid in decision-making regarding the type of hospital to which the patient should be transported – ideally, it should have both cardiology and otolaryngology facilities. However, in the hospital setting, in similar cases, the diagnosis of chest pain in patients with a tracheostomy tube should also include otolaryngology consultation, especially if the self-observation of the tube raises doubts about its patency.
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