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Multivessel spontaneous coronary artery dissection in an unlikely patient.

Jehangir W, Aly T, Bedran KH, Yousif A, Niemiera ML - Case Rep Cardiol (2015)

Bottom Line: When approaching the symptom of acute onset chest pain in a previously healthy 26-year-old male, anchoring heuristic presents a challenge to healthcare workers.One such condition, Spontaneous Coronary Artery Dissection (SCAD), is an uncommon and malefic presentation of coronary artery disease that can lead to myocardial infarction and sudden death.We present a case of SCAD in an otherwise healthy 26 year-old male who had been experiencing chest pain during and after sports activity.

View Article: PubMed Central - PubMed

Affiliation: Raritan Bay Medical Center, Perth Amboy, NJ 08861, USA.

ABSTRACT
When approaching the symptom of acute onset chest pain in a previously healthy 26-year-old male, anchoring heuristic presents a challenge to healthcare workers. This diagnostic error is the healthcare professional's tendency to rely on a previous diagnosis, and, in situations where a set of symptoms might mask a rare and deadly condition, this error can prove fatal for the patient. One such condition, Spontaneous Coronary Artery Dissection (SCAD), is an uncommon and malefic presentation of coronary artery disease that can lead to myocardial infarction and sudden death. We present a case of SCAD in an otherwise healthy 26 year-old male who had been experiencing chest pain during and after sports activity. In the young, athletic male with SCAD, the danger of diagnostic error was a reality due to the broad symptomatology and the betraying demographics.

No MeSH data available.


Related in: MedlinePlus

Showing total left anterior descending spontaneous dissection.
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fig3: Showing total left anterior descending spontaneous dissection.

Mentions: While playing cricket, a 26-year-old Indian Asian male without any significant past medical history experienced a two-week history of intermittent, retrosternal stabbing chest pain that radiated to his left arm and shoulder. The pain was pleuritic, positional, and associated with diaphoresis and nausea. The patient was diagnosed with costochondritis by his primary care physician. Seven days prior to admission, the patient had an upper respiratory tract infection with fever and chills. He denied smoking, drinking alcohol, or to using drugs; however, he reported that he had been drinking protein shakes for 3 years for muscle building. Upon physical exam, the patient was afebrile with a BP of 118/86 mmHg, PR of 111/min, and RR of 22/min. The remainder of the physical exam was completely unremarkable. Laboratory data showed Hb 15.6 g/dL, Hct 44.6, WBC 19.9 K/μL, platelet count 675 K/μL, glucose 157 mg/dL, BUN 21 mg/dL, Cr 1.2 mg/dL, Ca 9.7 mg/dL, albumin 4.7 g/dL, total protein 7.8 g/dL, sodium 137 mmol/L, potassium 3.3 mmol/L, chloride 98 mmol/L, and bicarbonate 20 mmol/L. Urine drug screen was negative. ECG showed ST elevation in the anterolateral leads (Figure 1). After consulting cardiology, the patient was taken to the cardiac catheterization lab for rescue angioplasty. A 95% mid-spiral right coronary artery dissection with total left anterior descending spontaneous dissection was demonstrated (Figures 2 and 3). Both the dissections were classified as type 1. The remaining vessels were normal. Left ventricular ejection fraction was measured at 15–20%. Percutaneous coronary intervention (PCI) to LAD and mid-RCA was performed. Vasculitis work-up was subsequently negative.


Multivessel spontaneous coronary artery dissection in an unlikely patient.

Jehangir W, Aly T, Bedran KH, Yousif A, Niemiera ML - Case Rep Cardiol (2015)

Showing total left anterior descending spontaneous dissection.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4402468&req=5

fig3: Showing total left anterior descending spontaneous dissection.
Mentions: While playing cricket, a 26-year-old Indian Asian male without any significant past medical history experienced a two-week history of intermittent, retrosternal stabbing chest pain that radiated to his left arm and shoulder. The pain was pleuritic, positional, and associated with diaphoresis and nausea. The patient was diagnosed with costochondritis by his primary care physician. Seven days prior to admission, the patient had an upper respiratory tract infection with fever and chills. He denied smoking, drinking alcohol, or to using drugs; however, he reported that he had been drinking protein shakes for 3 years for muscle building. Upon physical exam, the patient was afebrile with a BP of 118/86 mmHg, PR of 111/min, and RR of 22/min. The remainder of the physical exam was completely unremarkable. Laboratory data showed Hb 15.6 g/dL, Hct 44.6, WBC 19.9 K/μL, platelet count 675 K/μL, glucose 157 mg/dL, BUN 21 mg/dL, Cr 1.2 mg/dL, Ca 9.7 mg/dL, albumin 4.7 g/dL, total protein 7.8 g/dL, sodium 137 mmol/L, potassium 3.3 mmol/L, chloride 98 mmol/L, and bicarbonate 20 mmol/L. Urine drug screen was negative. ECG showed ST elevation in the anterolateral leads (Figure 1). After consulting cardiology, the patient was taken to the cardiac catheterization lab for rescue angioplasty. A 95% mid-spiral right coronary artery dissection with total left anterior descending spontaneous dissection was demonstrated (Figures 2 and 3). Both the dissections were classified as type 1. The remaining vessels were normal. Left ventricular ejection fraction was measured at 15–20%. Percutaneous coronary intervention (PCI) to LAD and mid-RCA was performed. Vasculitis work-up was subsequently negative.

Bottom Line: When approaching the symptom of acute onset chest pain in a previously healthy 26-year-old male, anchoring heuristic presents a challenge to healthcare workers.One such condition, Spontaneous Coronary Artery Dissection (SCAD), is an uncommon and malefic presentation of coronary artery disease that can lead to myocardial infarction and sudden death.We present a case of SCAD in an otherwise healthy 26 year-old male who had been experiencing chest pain during and after sports activity.

View Article: PubMed Central - PubMed

Affiliation: Raritan Bay Medical Center, Perth Amboy, NJ 08861, USA.

ABSTRACT
When approaching the symptom of acute onset chest pain in a previously healthy 26-year-old male, anchoring heuristic presents a challenge to healthcare workers. This diagnostic error is the healthcare professional's tendency to rely on a previous diagnosis, and, in situations where a set of symptoms might mask a rare and deadly condition, this error can prove fatal for the patient. One such condition, Spontaneous Coronary Artery Dissection (SCAD), is an uncommon and malefic presentation of coronary artery disease that can lead to myocardial infarction and sudden death. We present a case of SCAD in an otherwise healthy 26 year-old male who had been experiencing chest pain during and after sports activity. In the young, athletic male with SCAD, the danger of diagnostic error was a reality due to the broad symptomatology and the betraying demographics.

No MeSH data available.


Related in: MedlinePlus