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Orv Hetil ; 156(25): 1020-5, 2015 Jun 21.
Artigo em Húngaro | MEDLINE | ID: mdl-26170091

RESUMO

Chest pain is not uncommon among young patients below the age of 35 years, however, it is rarely caused by acute coronary syndrome. The rarity of coronary artery occlusion in this population can easily lead to diagnostic mistakes. The authors present the case history of a 19-year-old young female, who was admitted to the emergency department of a local hospital due to the sudden onset of chest pain and malaise. ST-segment elevation was seen on the electrocardiogram raising the possibility of aortic dissection, therefore, emergency thoracic computed tomographic scan was performed. This proved to be negative and the patient was transferred to the coronary care unit. Urgent coronarography was carried out, which revealed the total occlusion of the left main coronary artery. The occluded artery was successfully opened with percutaneous coronary intervention, but despite revascularisation the patient died on the second postoperative day due to asystole. Autopsy revealed thrombotic embolization of the left main artery with consequent extensive haemorrhagic necrosis, involving almost the whole left ventricle. The source of embolization was not found. The authors note that left coronary artery occlusion in young patients can be a diagnostic challenge, because symptoms can be mistaken with aortic dissection or pulmonary embolism.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Infarto Miocárdico de Parede Anterior/etiologia , Oclusão Coronária/complicações , Parada Cardíaca , Sistema de Condução Cardíaco/fisiopatologia , Ventrículos do Coração/patologia , Intervenção Coronária Percutânea , Tromboembolia/diagnóstico , Síndrome Coronariana Aguda/fisiopatologia , Dissecção Aórtica/diagnóstico , Infarto Miocárdico de Parede Anterior/fisiopatologia , Infarto Miocárdico de Parede Anterior/cirurgia , Autopsia , Angiografia Coronária , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/fisiopatologia , Diagnóstico Diferencial , Eletrocardiografia , Tratamento de Emergência , Evolução Fatal , Feminino , Parada Cardíaca/etiologia , Humanos , Necrose/etiologia , Tromboembolia/complicações , Tomografia Computadorizada por Raios X , Adulto Jovem
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