Author + information
- Jennifer A. Rossington, BSc, MBChB∗ (, )
- Matthew Balerdi, BSc, MBChB and
- Angela J. Hoye, MBChB, PhD
- ↵∗Reprint requests and correspondence:
Dr. Jennifer A. Rossington, Cardiology Department, Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire, HU16 5JQ, United Kingdom.
A 66-year-old female smoker with a background history of hypertension presented via the primary percutaneous coronary intervention pathway for suspected anterior ST-segment elevation myocardial infarction (Fig. 1). She had a several-day history of upper abdominal pain, with sudden worsening and radiation to the chest and back, associated with sweating and vomiting.
On arrival to the cardiac catheterization suite, she was tachycardic and hypertensive, requiring intravenous high-dose morphine for symptom control. Brief examination revealed normal cardiovascular findings and a tender upper abdomen with bloating. A trolley side transthoracic echocardiogram showed normal left ventricular systolic function and no significant valvular abnormality, but interestingly almost complete collapse of the left atrium (Fig. 2). This was thought to be possibly related to image acquisition limitations in the acute setting. We proceeded to coronary angiography via the right radial artery in the best interests of the patient in light of the electrocardiographic changes and no contraindications.
An initial angiographic image in the posteroanterior cranial view confirmed a normal left coronary artery system but abnormal cardiac silhouette (Figs. 3 and 4). Computed tomography was arranged, revealing a perforated volvulus of the stomach on a background of a paraesophageal hernia (Fig. 5).
She was transferred for urgent laparoscopic reduction of the incarcerated perforated gastric volvulus and repair of the stomach and hiatus. She is recovering well.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation