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Chest pain in a young female
Paul S Basel1, Daniel Reschke1, Michael D April1
1Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, United States.
The American Journal of Emergency Medicine
|January 21, 2018
Summary
Spontaneous coronary artery dissection (SCAD) can mimic ST elevation myocardial infarction (STEMI). Recognizing subtle ECG changes in SCAD is crucial for appropriate emergency department management, avoiding incorrect treatments.
Area of Science:
- Cardiology
- Emergency Medicine
Background:
- Acute Coronary Syndrome (ACS) is a frequent emergency department diagnosis, with ST elevation on ECG indicating severe coronary artery obstruction.
- Coronary atherosclerotic plaque rupture is the most common cause, but alternative etiologies exist.
Observation:
- Spontaneous Coronary Artery Dissection (SCAD) is an uncommon cause of ST elevation, particularly in patients lacking traditional atherosclerosis risk factors.
- A case presented a 43-year-old female with chest pain and atypical ECG findings: accelerated idioventricular rhythm, subtle ST elevation, and subsequent resolution.
Findings:
- SCAD requires distinct management strategies compared to traditional ACS.
- Subtle clinical and ECG manifestations of SCAD can be overlooked in the ED setting.
Implications:
- Emergency physicians must consider SCAD in patients presenting with ST elevation but without typical ACS risk factors.
- Timely identification of SCAD can prevent inappropriate treatment for coronary plaque rupture, improving patient outcomes.
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