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Assembly

The ‘Pain in my Heart’

Authors
Akesh Thomas, MBBS
Sajin M J Karakattu, MBBS
Department of Internal Medicine, East Tennessee State University, TN


Case

A 72-year-old female with a history of diabetes mellitus and hypertension presented to the emergency department with complaints of left-sided chest pain that started after an argument with her caregiver. In her own words, the deeds of the caregiver “left a pain in my heart.” Physical exam was normal except for mildly elevated blood pressure. Troponin I trended up to 0.57 ng/ml (normal <0.3 ng/ml). ECG obtained is given below. Her prior ECG two months ago was noted to be normal. The coronary angiogram obtained showed normal coronary arteries, and ventriculography is shown below.

ECG
FIGURE A
Ventriculography
FIGURE B

Question

What is the diagnosis and the appropriate management for this patient?

A. Acute myocardial infarction, thrombolysis
B. Stress cardiomyopathy, conservative management
C. Normal ECG and ventriculogram, discharge the patient
D. Coronary artery vasospasm, calcium channel blockers

Answer