This tube is called the esophagus. The following day, the patient underwent a barium esophagram for evaluation of his symptoms, as an esophagogastroduodenoscopy (EGD) was deferred given recent NSTEMI. Atypical symptoms do not necessarily rule out acute coronary syndrome. GERD may also lead to demand ischemia and cause NSTEMI through other mechanisms. The characteristics of common ECG abnormalities in specific anatomic locations are presented in Table 2.11. This study investigated whether coronary vasospasm could be a reason for elevated cTnI in this patient population. Accessed Oct. 8, 2020. All Rights Reserved. If the test result is elevated (in a range that indicates damage to heart tissue), this can mean that the patient had a heart attack very recently. Stress-induced (takotsubo) cardiomyopathy: Stress-induced release of neurohormonal factors and catecholamines that cause direct myocyte injury and transient dilatation of the ventricle. Ohlmann, P., et al., Diagnostic and prognostic value of circulating D-Dimers in patients with acute aortic dissection. Types 3-5 MI (grouped under a common ICD-10 diagnosis code for Other MI Types, or I21.A9) would rarely be diagnosed by hospitalists. Coronary vasospasm can be elicited by stimulation of alpha-adrenergic, histaminic, A community-based sample of 3557 participants showed that the frequency of elevated cTnT using was 0.7%,5 and typically associated with risk factors for heart disease or heart failure (HF). While at the hospital, the patient experienced a similar episode of nocturnal dyspnea, prompting a barium esophagram, which was suggestive of a stricture in the distal esophagus from long-standing GERD. This lack of blood supply can be due to an acute absolute or relative deficiency in coronary artery blood flow. The pain is often intense, and you might mistake it for heart pain, also known as angina. Elevated Goldman L, et al., eds. Esophageal spasms are sometimes associated with conditions such as heartburn or gastroesophageal reflux disease (GERD). (c) Sequential vein graft to right posterolateral and posterior descending artery with 40% proximal disease.