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Myocardial infarction in a 25-year-old woman
1Accident and Emergency Directorate, Guys and St Thomas' Hospital Trust, London, UK.
Insights
A young woman with chest pain experienced ST elevation on ECG, indicating a blocked artery. Further investigation revealed a clotting disorder, highlighting the importance of screening for coagulation abnormalities in such cases.
Area of Science:
- Cardiology
- Hematology
Background:
- Chest pain is a common presenting complaint in emergency departments.
- Electrocardiogram (ECG) is a crucial initial diagnostic tool for acute coronary syndromes.
- Coagulation abnormalities can predispose individuals to thrombotic events, including myocardial infarction.
Observation:
- A 25-year-old woman presented with recurrent chest pain.
- Initial ECG was normal, but a subsequent ECG showed significant ST elevation in anteroseptal leads.
- Coronary angiography revealed occlusion of the left anterior descending coronary artery.
Findings:
- The patient was diagnosed with a coagulation abnormality.
- This case highlights a rare presentation of myocardial infarction in a young individual secondary to a clotting disorder.
Implications:
- Clinicians should consider screening for coagulation disorders in young patients presenting with myocardial infarction.
- Thorough patient history and collateral information are vital for diagnosing complex cases, even those with seemingly non-specific presentations.
- Early identification of thrombophilia can guide appropriate anticoagulation therapy and prevent recurrent cardiovascular events.
Abstract:
A 25-year-old woman presented with chest pain. Electrocardiogram (ECG) on admission was normal. When she had recurrent chest pain a second ECG showed marked ST elevation in the anteroseptal leads. Coronary angiography confirmed occlusion of the left anterior descending coronary artery. She was subsequently found to have a coagulation abnormality. The case illustrates several important points. Inquiring about risk factors in patients with chest pain should include a question about abnormal clotting. It is important to exclude significant pathology in patients who may appear 'histrionic': inspection of a patient's belongings and collateral history may be invaluable.