Hiccup: a red flag to emergency physician?
Acute coronary syndrome (ACS) can present with atypical chest pain or symptoms not attributed to heart disease, such as epigastric pain, nausea, vomiting or hiccup. A hiccup is involuntary, paroxysmal inspiratory movement of the chest wall associated with diaphragm and accessory respiratory muscle contractions, with the synchronized closure of glottis. The center of hiccups is localized in C3–C5 segments of the spinal cord. There are various causes of protracted hiccups, including metabolic abnormalities, psychogenic disorders, malignancy, central nervous system pathology, medications, pulmonary disorders, or gastrointestinal etiologies. We present the case a 65-years-old man, with diabetes mellitus and hypertension, who presented to the Emergency Department for a intractable hiccup started two day ago, nausea and vomiting. A routine electrocardiogram was performed and showed an anterior myocardial infarction with ST elevation (STEMI). Troponin I peaked at 9,78 ng/mL An emergency coronary angiograhy showed obstruction on the proximal left anterior descending coronary artery and a stent was placed. In conclusion, although extremely common and usually benign, hiccup can occasionally be a symptom of serious underlying pathology such as STEMI. We present this case as a red flag to emergency physicians for the potential of hiccup to serve as the chief presenting symptom of STEMI.
