DOI: 10.1161/circ.148.suppl_1.16361 ISSN: 0009-7322

Abstract 16361: Atypical Presentation of Myocardial Ischemia Provoked by Food Ingestion

Abdul Rahman Akkawi, Sana Imran, Sean-Mikael Dodenhoff, Abhiram Challa, Ahmad Mahdi, Freidy Eid
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: A type 2 myocardial infarction typically occurs due to demand ischemia from a blood supply mismatch. Significant blockage can trigger coronary steal syndrome and worsen perfusion in areas with severe coronary artery disease (CAD). In this case, we highlight a patient who experienced a dynamic elevation in troponin levels after food consumption, ultimately necessitating coronary artery bypass graft surgery (CABG), shedding light on the diverse presentations of cardiac ischemia.

Case Presentation: A 49-year-old male with a history of hypertension, type 2 diabetes mellitus, obesity, recent stroke on dual antiplatelets, and non-obstructive CAD presented with chest discomfort over a period of two months. The patient denied associated symptoms and physical examination was unremarkable. Interestingly, the chest pain occurred specifically after meals. Extensive workup, including an EGD and CTA Abdomen, were negative. The symptoms were refractory to proton pump inhibitors (PPI). An EKG revealed dynamic precordial ST segment depressions, and troponin levels were elevated after meals on multiple occasions, gradually decreasing between meals. A left heart catheterization revealed severe five-vessel blockages; thepatient consequently required a quadrupleCABG. Following surgery, the patient reported a resolution of chest pain.

Discussion: Our patient developed chest pain and demonstrated elevated troponin levels after each meal. With an extensive negative workup, further evaluation was necessary. Theoretically, circulatory flow in the splanchnic circulation during food digestion can mimic physical activity. Additionally, a full stomach may irritate the diaphragm and lead to arrhythmias. This case highlights the potential role of meals as triggers for coronary artery disease in patients with critical coronary blockage. Demand cardiac ischemia can manifest with atypical presentations that may pose diagnostic challenges. It is essential to recognize the atypical presentations of myocardial infarction to aid in the timely diagnosis and treatment of this potentially life-threatening condition.

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