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Acute chest pain after bench press exercise in a healthy young adult

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ABSTRACT

Bench press exercise, which involves repetitive lifting of weights to full arm extension while lying supine on a narrow bench, has been associated with complications ranging in acuity from simple pectoral muscle strain, to aortic and coronary artery dissection. A 39-year-old man, physically fit and previously asymptomatic, presented with acute chest pain following bench press exercise. Diagnostic evaluation led to the discovery of critical multivessel coronary occlusive disease, and subsequently, highly elevated levels of lipoprotein (a). Judicious use of ancillary testing may identify the presence of “high-risk” conditions in a seemingly “low-risk” patient. Emergency department evaluation of the young adult with acute chest pain must take into consideration an extended spectrum of potential etiologies, so as to best guide appropriate management.

No MeSH data available.


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Cardiac catheterization, right anterior oblique projection with 25 degrees of caudal angulation; showing 100% left anterior descending occlusion, 90% occlusion of the circumflex, and 95% occlusion of the obtuse marginals 1 and 2.
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f2-oaem-8-073: Cardiac catheterization, right anterior oblique projection with 25 degrees of caudal angulation; showing 100% left anterior descending occlusion, 90% occlusion of the circumflex, and 95% occlusion of the obtuse marginals 1 and 2.

Mentions: Cardiac catheterization revealed critical multivessel CAD (Figure 2). There was 100% occlusion of the right coronary artery, 100% occlusion of the left anterior descending, 90% occlusion of the circumflex, and 95% occlusion of the obtuse marginals (one and two) with inferior wall akinesis (Figure 2). There was no evidence of coronary dissection. Hypotension refractory to pressor agents necessitated placement of an intra-aortic balloon pump. As the coronary lesions were extensive, angioplasty with stenting was not technically feasible. The patient underwent emergent four-vessel coronary revascularization. After surgery, cardiac function as determined by echocardiography improved from a pre-operative ejection fraction of 30% up to 40%. Diagnostic investigation of the patient’s unexpectedly severe (and previously asymptomatic) coronary occlusive disease included normal cholesterol and triglycerides; however, the patient was found to have highly elevated lipoprotein (a) (Lp [a]) at 251 mg/dL (normal, <30 mg/dL). Anticardiolipin antibody and antinuclear antigen were negative. As no patient identifiers are used and patient confidentiality is maintained in this single-case report, the Institutional Review Board (IRB) of Georgetown University, as per its IRB Case Reports policy, does not require patient consent for this study.


Acute chest pain after bench press exercise in a healthy young adult
Cardiac catheterization, right anterior oblique projection with 25 degrees of caudal angulation; showing 100% left anterior descending occlusion, 90% occlusion of the circumflex, and 95% occlusion of the obtuse marginals 1 and 2.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5036768&req=5

f2-oaem-8-073: Cardiac catheterization, right anterior oblique projection with 25 degrees of caudal angulation; showing 100% left anterior descending occlusion, 90% occlusion of the circumflex, and 95% occlusion of the obtuse marginals 1 and 2.
Mentions: Cardiac catheterization revealed critical multivessel CAD (Figure 2). There was 100% occlusion of the right coronary artery, 100% occlusion of the left anterior descending, 90% occlusion of the circumflex, and 95% occlusion of the obtuse marginals (one and two) with inferior wall akinesis (Figure 2). There was no evidence of coronary dissection. Hypotension refractory to pressor agents necessitated placement of an intra-aortic balloon pump. As the coronary lesions were extensive, angioplasty with stenting was not technically feasible. The patient underwent emergent four-vessel coronary revascularization. After surgery, cardiac function as determined by echocardiography improved from a pre-operative ejection fraction of 30% up to 40%. Diagnostic investigation of the patient’s unexpectedly severe (and previously asymptomatic) coronary occlusive disease included normal cholesterol and triglycerides; however, the patient was found to have highly elevated lipoprotein (a) (Lp [a]) at 251 mg/dL (normal, <30 mg/dL). Anticardiolipin antibody and antinuclear antigen were negative. As no patient identifiers are used and patient confidentiality is maintained in this single-case report, the Institutional Review Board (IRB) of Georgetown University, as per its IRB Case Reports policy, does not require patient consent for this study.

View Article: PubMed Central - PubMed

ABSTRACT

Bench press exercise, which involves repetitive lifting of weights to full arm extension while lying supine on a narrow bench, has been associated with complications ranging in acuity from simple pectoral muscle strain, to aortic and coronary artery dissection. A 39-year-old man, physically fit and previously asymptomatic, presented with acute chest pain following bench press exercise. Diagnostic evaluation led to the discovery of critical multivessel coronary occlusive disease, and subsequently, highly elevated levels of lipoprotein (a). Judicious use of ancillary testing may identify the presence of &ldquo;high-risk&rdquo; conditions in a seemingly &ldquo;low-risk&rdquo; patient. Emergency department evaluation of the young adult with acute chest pain must take into consideration an extended spectrum of potential etiologies, so as to best guide appropriate management.

No MeSH data available.


Related in: MedlinePlus