title: [25-year old patient with angina pectoris during religious fasting].
abstract: HISTORY AND PRESENTATION AT ADMISSION: A 25-year-old male patient presented with acute left sided chest pain. The patient reported no physical exercise but daytime fasting (with neither food nor liquid intake) which he had started several days before.
  
  
  METHODS
  ECG, echocardiography and chest X-ray were normal, but blood examination revealed elevated levels for creatine kinase (CK) and lactate dehydrogenase (LDH). Ischemic lactate ammonia test revealed no increase of lactate during exercise. Muscle biopsy confirmed suspected diagnosis of glycogen storage disease type V (McArdle's disease).
  
  
  METHODS
  As causal treatments are unavailable for McArdle's disease, careful counselling regarding adequate exercise and regular, carbohydrate rich nutrition are mandatory to ameliorate symptoms.
  
  
  CONCLUSIONS
  McArdle's disease represents a rare differential diagnosis of cardiac chest pain and somatoform myalgic complaints. When taking the patient's history, questions regarding the "Second wind"-phenomenon are helpful for initiating the adequate investigations early on.
authors: Universitäre Psychiatrische Kliniken Basel.
authors: C A
authors: CA
authors: Huber
authors: MVZ Neurologie, Universitätsklinik Köln.
authors: G
authors: G
authors: Wunderlich
authors: Institut für Neuropathologie, Universitätsklinik Köln.
authors: A
authors: A
authors: Brunn
authors: Institut für Neuropathologie, Universitätsklinik Köln.
authors: T
authors: T
authors: Blau
authors: Klinik und Poliklinik für Neurologie, Universitätsklinik Köln.
authors: G R
authors: GR
authors: Fink
authors: Klinik und Poliklinik für Neurologie, Universitätsklinik Köln.
authors: H C
authors: HC
authors: Lehmann
mesh_terms: D000328:Adult; D000787:Angina Pectoris / Q000209:etiology*; D001706:Biopsy; D003937:Diagnosis, Differential; D005215:Fasting / Q000009:adverse effects*; D006012:Glycogen Storage Disease Type V / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D007514:Islam; D008019:Life Style; D008297:Male; D018482:Muscle, Skeletal / Q000473:pathology; D010353:Patient Education as Topic; D012068:Religion and Medicine