A 50-year-old Vietnamese man arrived at Thomas Jefferson University Hospital's emergency department after having suffered for three days with intermittent chest pain. On the day of admission, the chest pain was more severe and persistent.

An electrocardiogram showed that he had suffered acute myocardial infarction, or heart attack. He was taken immediately to the cardiac catheterization laboratory, and coronary angiography revealed a completely blocked coronary artery.

The cause of the heart attack was an occlusion in a coronary artery, pictured left. Shown on the right, the artery opened after a stent placement.

The interventional cardiologist opened the artery with a small balloon and stent. The patient spent several days in the cardiovascular intensive-care unit, with heart failure and cardiogenic shock from his heart attack.

Fortunately, he survived and was ultimately sent home from the hospital on appropriate medical therapy.

But none of our tests gave us a clue as to something else found during the patient's initial physical exam: several circular bruises on his chest.

What could have caused those odd bruises?

Solution:

When his chest pain began, the patient first sought care from an Eastern medicine healer, who performed a common complementary and alternative medicine (CAM) procedure called cupping.

Cupping made national headlines when multiple Olympic athletes were seen last month with similar round bruises on their upper bodies.

Cupping has been in use for thousands of years, and remains popular today in both Eastern and Western cultures. The insides of small glass globes are briefly heated, then the globe is placed on the skin. As the air cools, a suction effect pulls the skin into the glass globe, leaving a well-delineated, circular bruise due to the breaking of small, superficial blood vessels in the skin.

CAM is commonly sought out for a variety of conditions and has been reported to be effective for some ailments. However, in this case, cupping only delayed treatment for a heart attack - a nearly fatal mistake.

If someone has symptoms that could suggest a heart attack such as sudden chest pain, arm and/or jaw pain, or sudden shortness of breath and/or sweating at rest, immediately call 911.

Never drive yourself, or drive someone who is having symptoms, to the hospital. Trained emergency workers are equipped to handle complications that can occur suddenly during a heart attack, such as cardiac arrest. Any delay in treatment of a heart attack leads to more complications and a lower chance of survival.

Gregary Marhefka, M.D., is associate professor of medicine at Sidney Kimmel Medical College and associate director of the cardiovascular ICU at Jefferson University Hospital; Michael Savage, M.D., is Ralph J. Roberts Professor of Cardiology at Kimmel, and director of the cardiac catheterization lab at Jefferson.