A soccer mom with chest pain: Spontaneous coronary artery dissection in a young woman.
Published Aug 1, 2017 · Benjamin Blackwood, Stefi F. Lee, O. Liebmann
Rhode Island medical journal
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Abstract
DR. BENJAMIN BLACKWOOD: Today’s patient is a 45-year-old woman who presents to our emergency department with acute onset of substernal chest pain. The patient was watching her son’s soccer game when she abruptly stood up from a sitting position to cheer. She had immediate onset of a squeezing chest tightness and pressure that radiated to her left arm and was associated with nausea and mild shortness of breath. She described the pain initially as an 8/10. The discomfort receded over time, but never completely abated, and about 2 hours after onset she came to the emergency department because she felt that her discomfort, which was now a 3/10, was unusual and persistent. The patient stated that she regularly exercised and jogged several miles 3-4 times per week. She had a history of hypertension, anxiety, and a total abdominal hysterectomy for uterine fibroids and adenomyosis. She was currently taking amlodipine and estrogen replacement therapy. She was a teacher, did not use tobacco or drugs, and was allergic to penicillin and sulfa medications. She did report multiple stressors in her life and stated that her mother had a myocardial infarction in her 60s. Upon arrival the patient had a blood pressure of 162/99, pulse of 68, and otherwise had normal vital signs. She looked quite well but stated she still had 1/10 residual chest discomfort. Her physical exam was significant for clear lungs, a normal s1s2 with occasional irregular beats, and strong 2+ pulses bilaterally in the carotid, radial, femoral, and dorsal pedis locations. Her abdominal, musculoskeletal, and neurologic exams were unremarkable. Due to the nature of her complaint an ECG was performed at triage.