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Case Reports in Medicine
Volume 2012, Article ID 182379, 3 pages
Case Report

Atypical Presentation of Acute Coronary Syndrome-Not ST Elevation: A Case Report

1Department of Cardiology, Catholic University of Rome, Via dei Gelsi 15, 71043 Manfredonia, Italy
2Cardiology Unit, “San Camillo de Lellis” Hospital, Foggia, Manfredonia, Italy
3Emergency Unit, “San Camillo de Lellis” Hospital, Foggia, Manfredonia, Italy
4Anesthesiology Unit, “San Camillo de Lellis” Hospital, Foggia, Manfredonia, Italy

Received 6 December 2011; Revised 19 January 2012; Accepted 31 January 2012

Academic Editor: Aldo Pietro Maggioni

Copyright © 2012 Nicola Vitulano et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


We describe the unexpected case of a 70-year-old man, with medical history of ischemic heart disease and surgery for aneurysm of abdominal aorta, who comes to the emergency department complaining of low-back pain without other symptoms or signs of organic failure. After a few hours we see a deterioration of physical conditions with pulmonary oedema, increase of blood pressure, changing in the ECG pattern, and worsening of left ventricular function with progressive increase of biomarkers for myocardial necrosis. So this pain has revealed the premature symptom of an acute coronary syndrome (ACS). After a short time a subsequent cardiac arrest complicates the clinical situation. After resuscitation, the patient undergoes successfully to coronary angiography and performed a percutaneous transluminal coronary angioplasty (PTCA).