VCOM Louisiana Research Day Program Book 2024

Case Studies

Yaroslav Zuyev, OMS-III; Tyson Hillock, OMS-III; Rezaul Islam, MD St. Francis Medical Center 46 TYPICAL EXERTIONAL ANGINA WITH NO ANGIOGRAPHIC CORONARY ARTERY DISEASE

Background: Cardiac syndrome X (CSX) is a cardiac condition that is a diagnosis of exclusion. Patients usually present with terrible chest pains suggestive of myocardial infraction but having angiograms done, there would be no occlusion that would cause obstructions in the coronary vessels that would result in chest pains suggestive of coronary artery disease. CSX is more commonly seen in women, but this case report sets the stage of a different clinical presentation of CSX, in a young fit male patient. The 38-year-old male patient presented to the emergency room three years ago with chest discomfort with radiation to the left arm and to the left jaw. The chest pain started after going on a jog and lasted for a couple of hours. Electrocardiogram was shown to be abnormal in terms of nonspecific ST changes and unremarkable troponin levels. The patient underwent a coronary angiogram which was unremarkable. After 3 years, the patient presented once more with chest heaviness that occurred again after going for a run. The patient’s troponins were unremarkable and electrocardiogram test showed new onset of AV block. Due to the severe chest pain, the patient received another coronary angiogram. This showed that the coronary vessels had no indications of occlusion. The patient was

discharged and scheduled to follow up with their cardiologist with extensive discussion about medications for their condition. This case report should bring a new light into the awareness of a classical presentation of this disease in an uncommon population group, and a way to identify this syndrome once exclusions have been made on previous hospitalizations. A 38-year-old male presented to the emergency department (ED) with the primary concern of severe chest pressure that radiated to left arm and jaw. The patient had vitals of a blood pressure of 173/110, and bradycardia with heart rate of 50 beats per minute. The leading diagnosis was a myocardial infraction (MI), the labs were done to rule out MI were the cardiac enzymes and electrocardiogram. These enzymes were negative indicating the chest pains were not coming from the heart, so other specialist were consulted, in attempt to rule out other causes of classical chest pain including GERD, pulmonary embolism, pneumonia. After these were ruled out and the patient continued to have 10 out of 10 chest pain, it was decided to do a coronary angiogram, in an attempt to have the best visualization of the coronary arteries in order to find signs of coronary disease. The angiogram was free from signs of coronary disease or occlusion. The patient

was discharged and told to follow up with the cardiologist. After further testing and doing myocardial perfusion scans and ruling out other causes for these typical anginal chest pains to give the diagnosis of cardiac syndrome X. Conclusions: Cardiac syndrome X (CSX) is an underdiagnosed condition since it is a diagnosis of exclusion. It is important for medical professionals to understand the unique presentation of this disease. The current medical literature for this condition relies heavy on other case reports and analysis done on other patients with this condition since this is a diagnosis of exclusion. Compared to other patients with this condition, the majority of patients with CSX are women, about 70% [1]. A study found that > 60% of those women were postmenopausal [2]. Compared to other patients with this condition it also found a common finding between these patients, having some co-metabolic disorders that cause endothelial damage such as diabetes, hypertension and hypercholesterolemia can lead to the development of this rare condition, so it’s important to monitor these labs for the associated conditions and treat associated conditions [3].

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