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Severe upper abdominal pain in a 43-year-old woman
  1. Elad Asher,
  2. Alexander Kogan,
  3. Amit Segev
  1. Leviev Heart Center, Sheba Medical Center Tel Hashomer, Tel-Aviv University, Tel Hashomer, Israel
  1. Correspondence to Dr Elad Asher, Heart Institute, Sheba Medical Center Tel Hashomer 5265601, Israel; el.asher{at}


Clinical introduction A 43-year-old healthy woman was transferred to our hospital due to severe upper abdominal pain during lunch. On arrival to the hospital she lost consciousness, had no pulse and no blood pressure; hence, the cardiopulmonary resuscitation was initiated and the patient was intubated. Echocardiography performed during the resuscitation revealed ejection fraction of 5% with global hypokinesia. The patient was put on extracorporeal membrane oxygenation and was transferred to the catheterisation laboratory. The initial angiography and the post percutaneous coronary intervention (PCI) images are shown in figure 1.

Figure 1

Images of (A) initial angiography and (B) post percutaneous coronary intervention.

Question What is the diagnosis?

  1. Aortic dissection

  2. Emboli to the left main coronary artery

  3. Plaque rupture causing acute ST segment elevation myocardial infarction

  4. Spasm

  5. Spontaneous coronary artery dissection


  • spontaneous coronary artery dissection
  • percutaneous coronary artery intervention
  • acute coronary syndrome

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.