A 42-year-old female presented to the hospital with a 2-day history of fever (39.3°C), worsening dyspnoea, chest tightness, reduced exercise capacity and dizziness. On further questioning it is revealed that her dyspnoea and chest tightness started 10 months ago and have been getting progressively worse. She says she experienced similar symptoms of chest pain 4 years ago but wasn’t investigated further as her symptoms subsided.

On this admission, bloods showed Hb 87, Troponin 10.05, NT pro-BNP 1,118, CRP <5.0. U&Es, LFTs & Bone Profile were all normal. An ECG was performed which showed poor R-wave progression in the anterior wall. Transthoracic echocardiogram (TTE) was also performed which showed regional wall motion abnormality of the left ventricle with reduced LVEF (32%) and an enlarged left ventricular end-diastolic diameter (67mm). Cardiac MRI was then performed to further evaluate the heart. Following these investigations, the patient underwent coronary angiography and eventually coronary artery bypass graft (CABG).

From left to right: 1) TTE results 2) Coronary angiography finding of woven coronary artery 3) Cardiac MRI showing infarction of the apex 4) Blood test results

Source: https://doi.org/10.3389/fcvm.2022.1034860

Case Summary & Questions written by Dr Ahmed Kazie

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