Left main stem/LCA arising from right coronary sinus with an interarterial course
Mohammad Waleed1, Ali Raza1, Tariq Minhaj2
1Department of Cardiology, Castle Hill Hospital, East Yorkshire, UK.
BMJ Case Reports
|July 13, 2014
Summary
This case highlights a 67-year-old woman with persistent chest pain, mimicking indigestion, despite no relief from antacids. Her complex medical history and family predisposition warrant thorough cardiac investigation.
Area of Science:
- Cardiology
- Internal Medicine
- Oncology
Background:
- A 67-year-old female patient with a history of hypertension, chronic obstructive pulmonary disease, pulmonary fibrosis, breast cancer, and hypercholesterolemia.
- The patient was on multiple medications including anastrazole, aspirin, and clopidogrel.
Observation:
- Presented with 4 months of severe, retrosternal, intermittent chest pain, described as burning and radiating to the left arm.
- Chest pain was unresponsive to antacids, suggesting a non-gastrointestinal etiology.
- Significant family history of premature myocardial infarction in two brothers.
Findings:
- The patient's symptoms and risk factors, including family history and medication list, raised suspicion for cardiac ischemia.
- Differential diagnosis considered gastrointestinal causes, but the nature and persistence of pain pointed towards cardiovascular origins.
Implications:
- Emphasizes the importance of considering cardiac causes in patients presenting with atypical chest pain, even with gastrointestinal symptoms.
- Highlights the need for comprehensive cardiovascular risk assessment in patients with multiple comorbidities and a strong family history of heart disease.
- Suggests that atypical presentations of ischemic heart disease require prompt and thorough diagnostic evaluation to prevent adverse outcomes.
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