title: Chest pain with raised troponin, ECG changes but normal coronary arteries.
abstract: 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.
authors.affiliation: Department of Cardiology, Princess Royal Hospital Telford, Telford, Shropshire, UK.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Amjad
authors.forename: Amjad
authors.initials: A
authors.lastname: Ali
authors.forename: Ahmed
authors.initials: A
authors.lastname: Bashir
authors.forename: Muhammed
authors.initials: M
authors.lastname: Ali
authors.forename: Muhammad Najeeb
authors.initials: MN
authors.lastname: Azam
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000368:Aged; D001014:Aortic Aneurysm / Q000150:complications* / Q000175:diagnosis; D002637:Chest Pain / Q000097:blood / Q000209:etiology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006801:Humans; D011655:Pulmonary Embolism / Q000175:diagnosis; D011859:Radiography; D019210:Troponin I / Q000097:blood
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D019210:Troponin I; C036309:fibrin fragment D