Chest pain after emotional and physical upset

doi:10.1136/bmj.a107

Published 3 September 2008, doi:10.1136/bmj.a107
Cite this as: BMJ 2008;337:a107

Endgames

Case Report

Chest pain after emotional and physical upset

P Parulekar, senior house officer, M Z O Khawaja, specialist registrar, E T McWilliams, consultant

¹ Department of Cardiology, Conquest Hospital, St Leonards-on-Sea TN37 7RD

drzeeshan@doctors.org.uk

The first 150 words of the full text of this article appear below.

A 61 year old white woman attended her local accident and emergencydepartment with severe central chest pain. After being chasedby two large terrier dogs. The pain was not relieved by nitroglycerinespray given in the ambulance. An electrocardiogram showed anterolateralST segment depression, with an elevated troponin T of 1.25 µg/l.She had no cardiovascular risk factors. Non-ST elevation myocardialinfarction was diagnosed, and the patient was treated accordingly.

Coronary angiography showed normal coronary arteries, but theleft ventriculogram showed a large area of apical hypokinesiswith moderate impairment of left ventricular systolic function.

The patient was readmitted several weeks later with furtherchest pain. An electrocardiogram showed no new changes withno rise in the cardiac troponin. An echocardiogram showed thather left ventricular systolic function had almost returned tonormal.

1. What is the diagnosis?

2. Which patients are most at risk?

3. How should these . . . [Full text of this article]