A 16 year old boy with chest pain

• Published in: BMJ (Online) Vol. 349; no. oct15 7; p. g6172
• Main Authors: Walker, Andrew M N, Parviz, Yasir, Heppenstall, James, Best, James, Grech, Ever D
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 15-10-2014; BMJ Publishing Group LTD
• Subjects: Acute coronary syndromes; Adolescent; Age; Anticoagulants; Chest Pain - diagnosis; Congenital diseases; Coronary Thrombosis - diagnosis; Coronary vessels; Diagnosis, Differential; Dissection; Electrocardiography; Embolisms; Heart attacks; Humans; Male; Medical imaging; Molecular weight; Mortality; Myocardial Infarction - diagnosis; Patients; PICTURE QUIZ; Thrombophilia - complications; Tomography; Veins & arteries
• ISSN: 0959-8138; 1756-1833; 1756-1833
• DOI: 10.1136/bmj.g6172

Congenital coronary abnormalities can increase the likelihood of myocardial infarction, possibly because of compressive effects of the myocardium on arteries with an aberrant course. 2 The presence of a patent foramen ovale or an atrial septal aneurysm may lead to paradoxical embolism into the coronary circulation, although such cases are extremely rare. 3 Other rare embolic causes of myocardial infarction in young people include septic emboli from endocarditis (left sided) or clots formed around a left atrial myxoma. If there is more than a 120 minute delay between the availability of primary percutaneous coronary intervention and the time that a fibrinolytic agent could have been administered, fibrinolysis should be used. 16 In the case of a delay in the availability of emergent angiography, investigative strategies such as serial troponin testing, focused echocardiography to assess for the presence of regional wall motion abnormalities or identify pericarditis, or coronary computed tomography scanning may be used to help elucidate the diagnosis. Intravascular ultrasound was used to further elucidate the disease process within the right coronary artery (fig 5 ). Because coronary flow was normal, a stent was not inserted.