Abstract
Evaluation of acute chest pain can be extremely difficult and challenging. This diagnosis comprehends several causes, including benign and potentially lethal causes. Most of the time, the diagnosis can be done with the history and ordinary tests such as electrocardiogram, chest x-ray and myocardial enzymes. The coronary angiotomography is a new tool that can safely rule out acute coronary syndrome, being performed in patients with low to middle probability of acute coronary syndrome. The present report describes a young woman that presented to the emergency unit with atypical chest pain and myocardial enzyme elevation. Miocarditis was the initial diagnosis The patient was submited to a coronary angiotomography with late enhancement research. The coronary angiotomography demonstrated zero calcium score with a high degree stenosis in the coronary descending artery and late enhancement in anterior wall demonstrating myocardial necrosis. It was performed coronary catheterization and angioplasty afterwards.
Highlights
Evaluation of acute chest pain can be extremely difficult and challenging
The present report describes a young woman that presented to the emergency unit with atypical chest pain and myocardial enzyme elevation
The patient was submited to a coronary angiotomography with late enhancement research
Summary
Síndrome coronariana aguda em paciente jovem com sintomas atípicos. A angiotomografia coronariana tem sido utilizada nos casos de dor torácica aguda com baixa ou intermediária probabilidade de síndrome coronariana aguda, permitindo sua exclusão e conseqüente alta precoce dos pacientes. Apresentamos relato de caso de uma paciente jovem com dor precordial atípica e marcadores de necrose miocárdica discretamente elevados. Considerando-se a epidemiologia e o quadro clínico da paciente, foi feita hipótese diagnóstica inicial de miocardite. A angiotomografia cardíaca com pesquisa de realce tardio foi solicitada. Apesar do escore de cálcio ter sido zero, foi diagnosticada lesão estenosante grave no terço médio da artéria coronária descendente anterior com realce tardio na parede anterior do ventrículo esquerdo, compatível com necrose miocárdica. Palavras-Chave: Dor no peito; Síndrome coronariana aguda; Tomografia; Angiografia/método; Miocardite.
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