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Chest pain with elevated troponin in a middle-aged man
  1. Ahmed Mohamed,
  2. Laisha Gogola,
  3. Amardeep Dastidar
  1. Southmead Hospital, North Bristol NHS Trust, Bristol, UK
  1. Correspondence to Dr Ahmed Mohamed, Southmead Hospital, Bristol BS10 5NB, UK; a.magdeldin{at}

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Clinical introduction

A man in his late 50s with a medical history of multiple sclerosis presented with sudden-onset sharp central chest pain, which radiated to the back, jaw and neck. CT aorta ruled out aortic dissection. Blood results showed dynamic troponin-T rise and his ECG showed T-wave inversion in inferolateral leads. He had a coronary angiography. It showed smooth unobstructed right coronary artery and left coronary system was smooth walled except for short stenotic segment in the circumflex artery (moderate-severe) (figure 1A). Spontaneous coronary artery dissection was suspected. He was treated with optimum medical therapy and discharged home.

Figure 1

(A,B) Coronary angiogram of the …

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  • Contributors All the authors contributed equally.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Obtained.

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