Acta Scientific Gastrointestinal Disorders (ISSN: 2582-1091)

Case Report Volume 3 Issue 3

ST-Segment Elevation in Lead aVR in the Setting of Acute Thromboembolic Occlusion of the Superior Mesenteric Artery

Ikuto Takeuchi, Kei Jitsuiki, Ken-ichi Muramatsu, Yoshihiro Kushida, Hiroki Nagasawa, Jun Shitara, Hiromichi Ohsaka, Yasumasa Oode, Kazuhiko Omori and Youichi Yanagawa*

Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan

*Corresponding Author: Youichi Yanagawa, Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan.

Received: December 13, 2019; Published: February 17, 2020

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Abstract

  A 78-year-old woman with a history of pneumonia and arrhythmia was found having fallen down in her living room by her family after complaining of epigastralgia. She vomited once. She was transported by a physician-staffed helicopter. She showed epigastralgia, vomiting, restlessness and mild tenderness of the abdomen. Her electrocardiogram showed ST elevation in the lead aVR, but ultrasound of the heart did not show hypokinesis before the helicopter departed from the rendezvous zone. During transportation, she underwent infusion of nitroglycerin, metoclopramide and fentanyl. On arrival, her vital signs were as follows: Glasgow Coma Scale, E1V1M4; blood pressure, 170/70 mmHg; heart rate, 66 beats per minute; percutaneous saturation of oxygen under 10 L O2/minute, 100%; body temperature, 35.9°C. The main results of a blood gas analysis, cell blood count and biochemical study were white blood cell count, 11,800/mm3; lactate, 8.6 mmol/L; D-dimer, 0.8 μg/ml and negative findings for a qualitative test for troponin T. Enhanced computed tomography demonstrated obstruction of the superior mesenteric artery, so she underwent trans-arterial thrombolysis. After this treatment, her symptoms subsided. Follow-up blood tests showed findings in the normal range of troponin T. She was discharged on foot. This is the first case of ST-segment elevation in the lead aVR in the setting of acute thromboembolic occlusion of the superior mesenteric artery. Based on previous records and the present case, physicians should evaluate both occlusion of the SMA and acute coronary syndrome for patients with epigastralgia and ST-segment elevation in the lead aVR.

Keywords: ST-Segment Elevation; aVR; Acute Superior Mesenteric Artery Occlusion

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Citation

Citation: Youichi Yanagawa., et al. “ST-Segment Elevation in Lead aVR in the Setting of Acute Thromboembolic Occlusion of the Superior Mesenteric Artery”. Acta Scientific Gastrointestinal Disorders 3.3 (2020): 01-07.



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