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CASE REPORT
Chest pain with raised troponin, ECG changes but normal coronary arteries
  1. Ayesha Amjad1,
  2. Amjad Ali2,
  3. Ahmed Bashir3,
  4. Muhammed Ali3,
  5. Muhammad Najeeb Azam4
  1. 1Department of Cardiology, Princess Royal Hospital Telford, Telford, Shropshire, UK
  2. 2Department of General Surgery, Shrewsbury and Telford NHS Trust, Princess Royal Hospital, Telford, UK
  3. 3Department of Cardiology, Princess Royal Hospital Telford, Birmingham, West Midland, UK
  4. 4Department of Cardiology/Medicine, Princess Royal Hospital, Telford, UK
  1. Correspondence to Dr Ayesha Amjad, ayesha.amjad{at}nhs.net

Summary

A 65-year-old woman presented to A&E department, with acute onset central chest pain and dyspnoea. ECG showed dynamic T wave changes while 12 h troponin was elevated. A diagnosis of acute coronary syndrome was made and she underwent an inpatient coronary angiogram. Although her coronary arteries were normal, symptoms persisted and D-dimers were found to be elevated. This led to a CT pulmonary angiogram, which ruled out pulmonary embolism, but uncovered a large ascending aortic aneurysm with a contained leak. She was immediately transferred to regional cardiothoracic unit for urgent surgical intervention. This case report illustrates the importance of a good clinical history, physical examination and timely investigations. It also emphasises that not all chest pain events with elevated troponin level are due to acute coronary syndrome and that alternative diagnoses should still be considered.

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