Acute chest pain in a young man with low cardiovascular risk profile

Clinical introductionVignette A man in his 40s presented to our emergency department with sudden onset of severe central chest pain radiating to his left arm. He was sweaty, clammy and had accompanying breathlessness. There was no antecedent angina. His cardiovascular risk profile was low except for being a smoker (15 cigarettes per day). There was no medical history and he was not on any medical treatment. The 12-lead ECG showed sinus rhythm with hyperacute T waves in leads V3 and V4. Coronary angiography was performed using right radial access. The right coronary artery was small and free of disease. The left system showed no disease in the left main stem, but mild plaque disease in the dominant left circumflex artery. Angiographic findings of the left anterior descending artery are shown in figure 1A. Intravascular ultrasound was also performed (figure 1B).
Source: Heart - Category: Cardiology Authors: Tags: Image challenges Source Type: research