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Clinical Diabetes 20:101-102, 2002
© American Diabetes Association ®, Inc., 2002

Case Study

Case Study: Atypical Myocardial Infarction in a Man With Type 2 Diabetes

Craig D. Wittlesey, MD


   Presentation
 
F.E., a 54-year-old man with a history of type 2 diabetes, hypertension, and Reiter’s syndrome with prior hospitalizations for pneumonia and sepsis presented to the hospital emergency room complaining of chest pain, weakness, and fatigue. His chest pain was pleuritic in nature, worsening with movement and deep breathing. When he was motionless, the pain completely resolved.

F.E.’s electrocardiogram showed Q waves in leads II, III, and aVF, a new right bundle branch block, and mild ST segment elevation in leads V4 through V6. An urgent echocardiogram was ordered to differentiate between pericarditis and ischemia. The echocardiogram showed marked motion abnormalities in the inferior posterior, lateral wall. An initial troponin I was 238 ng/ml (normal range 0–2.5 ng/ml).

The patient was taken for emergent cardiac catheterization. This demonstrated an occluded right coronary artery that was opened with primary angioplasty and stent placement.


   Questions
 

  1. Is silent ischemia or atypical presentation of myocardial ischemia more common in diabetes?
  2. What other disease states may predispose to the development of atypical chest pain syndromes?
  3. What is the proposed mechanism for atypical or silent ischemia in diabetes?
  4. Which patients with diabetes should undergo myocardial assessment?


   Commentary
 
Manifestations of . . . [Full Text of this Article]


   Clinical Pearls
 

   Footnotes
 

   REFERENCES
 

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Diabetes Diabetes Care Clinical Diabetes Diabetes Spectrum
Copyright © 2002 by the American Diabetes Association.