RT Journal Article
SR Electronic
T1 A 33-year-old man with atypical chest pain
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 474
OP 474
DO 10.1136/heartjnl-2016-310278
VO 103
IS 6
A1 Alastair J Moss
A1 Marc R Dweck
A1 Andrew D Flapan
YR 2017
UL http://heart.bmj.com/content/103/6/474.abstract
AB 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 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? MyocarditisMyocardial bridgingKawasaki's diseaseAtherosclerotic plaque ruptureEosinophilic coronary monoarteritis