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Number 07-12: Troponin +ve Chest pain, normal coronaries

 

Case from: Andrew Flett, Mark Westwood, Simon Kennon. Department of cardiology, The Heart Hospital, London, UK and Chase Farm Hospital, London UK.

Clinical: 6 months ago, a 48 year old body builder had troponin positive chest pain with inferior T wave inversion on ECG and normal coronary angiography. Echo had suggested possible inferior hypokinesia. Ongoing clinical uncertainty.

CMR findings:
1.Normal global LV function
2.Minor inferior wall hypokinesia
3.Inferior wall partial thickness late gadolinium enhancement in the distribution of the right coronary artery

Interpretation:
CMR resolved clinical uncertainty in this case of occult MI with normal epicardial arteries. CMR provides a diagnosis in more than 50% of such patients, particularly myocarditis or missed MI. In this case, spontaneous coronary dissection, transient thrombotic occlusion (with or without plaque rupture, but without residual stenosis) or a vasospastic aetiology are possible causes.

Scanner: Siemens Avanto

References:
Bellenger NG ET AL. J Inves Cardio let al; 2006;18:594-8

Assomull RG et al. E Heart J 2007;28:1242-9

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Discrepancies between cardiovascular magnetic resonance and Doppler echocardiography in the measurement of transvalvular gradient in aortic stenosis: the effect of flow vorticity

Garcia J, Capoulade R, Le Ven F, Gaillard E, Kadem L, Pibarot P and Larose ?
Journal of Cardiovascular Magnetic Resonance 2013, 15:84 (20 September 2013)

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