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Number 07-12: Troponin +ve Chest pain, normal coronaries
Case from: Andrew Flett, Mark Westwood, Simon Kennon. Department
of cardiology, The Heart Hospital, London, UK and Chase Farm Hospital, London
UK.
Clinical: 6 months ago, a 48 year old body builder had troponin
positive chest pain with inferior T wave inversion on ECG and normal coronary
angiography. Echo had suggested possible inferior hypokinesia. Ongoing clinical
uncertainty.
CMR findings:
1.Normal global LV function
2.Minor inferior wall hypokinesia
3.Inferior wall partial thickness late gadolinium enhancement in the distribution
of the right coronary artery
Interpretation:
CMR resolved clinical uncertainty in this case of occult MI with normal epicardial
arteries. CMR provides a diagnosis in more than 50% of such patients, particularly
myocarditis or missed MI. In this case, spontaneous coronary dissection, transient
thrombotic occlusion (with or without plaque rupture, but without residual stenosis)
or a vasospastic aetiology are possible causes.
Scanner: Siemens Avanto
References:
Bellenger NG ET AL. J Inves Cardio let al; 2006;18:594-8
Assomull
RG et al. E Heart J 2007;28:1242-9
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