SHM Converge Scientific Abstract ePoster Gallery-Pharyngeal Pain as an Unusual Presentation of Myocardial Infarction

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This case describes a 76-year-old man with benign prostatic hyperplasia and ulcerative colitis who presented to the emergency department with a tight, painful throat sensation lasting five days. He initially assumed the symptoms were due to acid reflux and took omeprazole. He had no smoking history or family history of cardiovascular disease.<br /><br />On examination, he was tachycardic to 130 beats per minute, but otherwise had an unremarkable physical exam. Laboratory testing showed markedly elevated troponin, rising from 2.92 ng/ml to a peak of 80 ng/ml. His ECG demonstrated q waves in V1–V3 and ST-segment elevations in V1–V5, I, and aVL, with reciprocal ST depressions in the inferior leads, consistent with acute myocardial infarction.<br /><br />Coronary angiography revealed complete occlusion of the ostial left anterior descending (LAD) artery and 90% stenosis of the first obtuse marginal branch of the left circumflex artery. He underwent placement of two drug-eluting stents from the ostial to proximal LAD with good angiographic results. The procedure was complicated by hemodynamic instability, requiring intra-aortic balloon pump support. After IABP removal, he later underwent staged PCI of the obtuse marginal lesion with balloon angioplasty and another drug-eluting stent.<br /><br />The report emphasizes that myocardial infarction can present atypically, including as epigastric discomfort, nausea, sore throat, toothache, or ear pain. Pharyngeal pain may be the only symptom of acute coronary syndrome and can lead to delayed diagnosis, particularly when patients first seek care from non-cardiology providers. Shared vagal innervation may explain this unusual pain pattern. The case highlights the importance of considering cardiac ischemia in patients with isolated throat pain to enable prompt ACS evaluation and improve outcomes.

Asset Subtitle

Syed Mohammad Mazhar Uddin

Meta Tag

Author List Aatera Haq, Arafat Farooqui, Avi Miller, Bilal Malik, Britney M. Clemen, Nnamdi Chukwuka, Omair Khan, Sanjay Maheshwari, Sapna Kumari, Syed Mohammad Mazhar Uddin

Category Clinical Vignettes

Concept Acute Coronary Syndrome

Concept Myocardial Infarction

Concept Troponin

Concept ST Elevation

Concept Coronary Angiography

Distinguished Non-Finalist

Presenter Organization Maimonides Medical Center

Presenting Author Syed Mohammad Mazhar Uddin

Track Adult

Keywords

myocardial infarction

atypical presentation

throat pain

acute coronary syndrome

left anterior descending artery

coronary angiography

drug-eluting stent

troponin elevation

intra-aortic balloon pump

ulcerative colitis

Acute Coronary Syndrome

Myocardial Infarction

Troponin

ST Elevation

Coronary Angiography