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Old 09-24-2012
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Question Chest Pain Diagnosis

A 44 year old female presents to the emergency department with chest pain. The pain has been intermittent for months and atypical, occurring sometimes with exertion and sometimes at rest. She has no past medical history. EKG shows ST segment elevation. Cardiac enzymes are negative.
Which of the following most likely be found on an Angiogram ?

A. Abnormality only with administration of ergonovine
B. Coronary artery aneurysm
C. Fibromuscular dysplasia
D. Right coronary artery occlusion
E. 99% left anterior descending artery stenosis
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Old 09-24-2012
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A

She has Prinzmetal angina, which is an atypical cause of pain and is seen in younger patients than the other 2 causes of angina.

The unpredictable pattern + (not mentioned here) the fact that often awakens patients from sleep are common clues.

Tx is with Ca++ blockers
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Old 09-24-2012
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A. Abnormality only with administration of ergonovine

Quote:
It can induce spasm of the coronary arteries. It is used to diagnose Variant (Prinzmetal's) angina.
While it acts at alpha-adrenergic, dopaminergic, and serotonin receptors (the 5-HT2 receptor), it exerts on the uterus (and other smooth muscles) a powerful stimulant effect not clearly associated with a specific receptor type.
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