Early Detection of Acute Myocardial Infarction by Routine Computed Tomography of the Chest: a case report

Reprint requests to: Dr. Yu-Shien Ko The First Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital. No. 5, Fu Sing Street, Gueishan, Taoyuan 333, Taiwan, R.O.C. Evaluat ion of chest pain in the emergency department (ED) is a formidable chal lenge. It is established that multidetector computed tomography (MDCT) can detect the changes of myocardial perfusion after acute myocardial infarction (MI). However, there were few studies about MDCT changes before ECG and cardiac biomarkers confirmed acute myocardial infarction. We report a case presented to the ED with sharp chest pain. MDCT performed for suspected aortic dissection showed decrease myocardial enhancement, suggestive of acute MI before ECG changes and rises of cardiac enzymes, but no evidence of aortic dissection. Acute myocardial infarction was subsequently confirmed by both the ECG changes and increased levels of cardiac biomarkers. Chest pain, a common presenting complaint of patients in the emergent department (ED) is diagnostically challenging since the etiologies include both benign and catastrophic causes. The initial clinical workup should focus on the immediate recognition and exclude acute life-threatening conditions, such as acute ischemic heart disease, aortic dissection, and pulmonary embolism. Initial normal electrocardiograms (ECG) and cardiac markers cannot exclude myocardial infarction in an ED patient with chest pain, and additional diagnostic tests may be required to rule out other life-threatening diseases. Contrast-enhanced mult idetector computed tomog raphy ( M DCT) i s w idely accepted and rout inely used as a pr imar y emergent tool to assess the presence of pulmonary embolism or aor t ic dissect ion [1, 2]. We repor t an acute MI case depicted by urgent 4-detector non-ECG-gated MDCT which was requested initially with clinical suspicion of aortic dissection.