A 38-year-old female with a medical history significant only for a cholecystectomy for cholelithiasis presented to an outside hospital with a one day history of sharp, non-radiating midsternal chest pain that began when she bent over to pick something up. She has associated light-headedness and dizzinesswhen she stood up, as well as palpitations, diaphoresis, and a sense of throbbing in her left arm. The symptoms persisted at rest for one hour before the patient arrived at the outside hospital. She was found to be in new-onset atrial fibrillation witha rapid ventricular rate up to 160 beats per minute. A diltiazeminfusion was started which resulted in a decrease of the heart rate to 100 beats per minute. Her first troponin was <0.05 ng/mL, but a subsequent troponin was 0.59 ng/mL, prompting theinitiation of a heparin infusion for acute coronary syndrome. Atthis point, she was transferred to Thomas Jefferson University Hospital for further management. Her chest pain had resolved without any other medication, and she remained chest pain freethrough the rest of her hospital course. Of note, she admitted tousing alcohol, tobacco, and cocaine two days prior to admission.Her only medication is a daily oral contraceptive pill.
Shah, MD, Gunjan
"Chest Pain and Troponin Leak in a Healthy 38-year-old Female,"
The Medicine Forum:
Vol. 12, Article 18.
Available at: http://jdc.jefferson.edu/tmf/vol12/iss1/18