When the anamnesis is the key element in estabilishing the diagnosis of a young patient with chest pain, electrocardiographic changes, enzymatic dynamics

Objective: We present a case of a 35 year old patient with no known history of cardiovascular disease, repor-ted by a territorial hospital as acute coronary syndrome in the context of an earlier thoracic pain with an onset of one hour, ST segment elevation in the inferior area and increased myocardial cytolysis enzymes.

Methods: At admission, hemodynamically stable pa-tient, BP 130/90 mmHg, HR 100/min, ST segment elevation in the inferior area, echocardiographic left ventricle without dilatation or hypertrophy, with a systolic function slightly diminished on the basis and hipokinesy of the inferior ventricular wall, without pericardial fluid or significant haemodynamic valvu-lopathy. Emergency coronarography revealed normal angiographic coronary arteries. Biologically, an im-portant inflammatory syndrome (VSH =54mm/1h, CRP=58 mg/l, Fibrinogen=787 mg/l) was associated with a declarative presence of a respiratory infection with laterocervical adenopathies in recent history. An-ti-inflammatory therapy was instituted and pharyngeal exudate was harvested which was positive for Group A Strepotococ beta-hemolytic.

Rezults: Incidentally, the patient reported that the 6-year-old son had a febrile rash for several weeks. In this context, the child was diagnosed with scarlet fever. The presence of myocarditis, inflammatory syndrome, fever and pharyngeal exudate positive for Group A hemolytic Streptococcus B were the arguments for es-tablishing the diagnosis of rheumatic carditis. The patient received anti-inflammatory and antibiotic treat-ment with a favorable short-term evolution objectified by significant improvement in the longitudinal strain of the left ventricle and the remission of symptomatology. Conclusions: The presence of chest pain with electrical and enzymatic dynamics in the young can be caused by a non-coronary pathology. In the present case, anam-nesis was the key element that allowed the diagnosis of scarlet fever in the child and rheumatic carditis at the father, pathology with possible severe cardiovascular complications in the long term.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)