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Severe upper abdominal pain in a 43-year-old woman
Elad Asher1, Alexander Kogan1, Amit Segev1
1Leviev Heart Center, Sheba Medical Center Tel Hashomer, Tel-Aviv University, Tel Hashomer, Israel.
Clinical Introduction:
A 43-year-old healthy woman was transferred to our hospital due to severe upper abdominal pain during lunch. On arrival to the hospital she lost consciousness, had no pulse and no blood pressure; hence, the cardiopulmonary resuscitation was initiated and the patient was intubated. Echocardiography performed during the resuscitation revealed ejection fraction of 5% with global hypokinesia. The patient was put on extracorporeal membrane oxygenation and was transferred to the catheterisation laboratory. The initial angiography and the post percutaneous coronary intervention (PCI) images are shown in figure 1.heartjnl;103/20/1650/F1F1F1Figure 1Images of (A) initial angiography and (B) post percutaneous coronary intervention.
Question:
What is the diagnosis?Aortic dissectionEmboli to the left main coronary arteryPlaque rupture causing acute ST segment elevation myocardial infarctionSpasmSpontaneous coronary artery dissection.
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