An unexpected diagnosis after unstable angina

摘要

A 78-year-old man presented to our emergency department in October, 2005, with a 6 h history of severe letiostemal, non-radiating precordial pain, described as "someone gripping the inside of my chest". The pain was episodic, lasting for seconds, followed by complete relief for 3-5 min. His medical history included ischaemic heart disease, chronic obstructive pulmonary disease, and osteoarthritis. Since coronary-artery grafting 3 years previously he had had no further angina. Medications were isosorbide mononitrate, simvastatin, aspirin, and omeprazole. Clinical examination was unremarkable. ECG showed T-wave inversion in leads aVL, and V2 to V5. Troponin T was normal (<0 03 ng/mL), His full blood count and coagulation screen were within normal limits. Chest radiography was normal. An acute coronary syndrome was diagnosed, and treatment with subcutaneous low-molecular-weight hepaiin (1 mg/kg twice daily) was given.