A 33-year-old man with atypical chest pain

Heart. 2017 Mar;103(6):474. doi: 10.1136/heartjnl-2016-310278. Epub 2016 Sep 15.

Abstract

Clinical introduction: A 33-year-old man with no history of coronary artery disease presented to the rapid access cardiology clinic with an episode of atypical anginal chest pain. He had a 15 pack-year history of smoking and a family history of myocardial infarction under the age of 55. Physical examination and exercise ECG testing were unremarkable. On assessment in the cardiology clinic, blood sampling was notable for an elevated high-sensitivity troponin I of 61 ng/L (99% upper reference level, 34 ng/L). A coronary CT angiogram was performed (figure 1).

Question: Which of the following best explains this presentation? MyocarditisMyocardial bridgingKawasaki's diseaseAtherosclerotic plaque ruptureEosinophilic coronary monoarteritis.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Angina Pectoris / etiology*
  • Biomarkers / blood
  • Computed Tomography Angiography
  • Coronary Angiography / methods
  • Coronary Artery Disease / complications*
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / therapy
  • Coronary Occlusion / etiology
  • Coronary Occlusion / therapy
  • Coronary Vessels* / diagnostic imaging
  • Disease Progression
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Male
  • Percutaneous Coronary Intervention
  • Plaque, Atherosclerotic*
  • Platelet Aggregation Inhibitors / therapeutic use
  • Rupture, Spontaneous
  • Troponin I / blood
  • Up-Regulation

Substances

  • Biomarkers
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Platelet Aggregation Inhibitors
  • Troponin I