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A 33-year-old man with atypical chest pain
  1. Alastair J Moss1,
  2. Marc R Dweck1,
  3. Andrew D Flapan2
  1. 1Centre for Cardiovascular Science, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Alastair J Moss, Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4TJ, UK; alastairmoss{at}gmail.com

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).

Figure 1
Figure 1

CT multiplanar reformatting of the left anterior descending artery with vessel wall analysis of a proximal (blue) and distal (red) segment.

Question Which of the following best explains this presentation?

  1. Myocarditis

  2. Myocardial bridging

  3. Kawasaki's disease

  4. Atherosclerotic plaque rupture

  5. Eosinophilic coronary monoarteritis

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/heartjnl-2016-310278

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