Case presentation
A 22-year-old newly married female presented to our emergency department with recurrent intermittent attacks of retrosternal stabbing chest pain for a one-month duration. The pain typically lasted for a few minutes, radiated to the back and both shoulders, and was associated with nausea. She reported an increased awareness of heartbeats with physical activity and relief upon sitting down or lying flat.
Despite three previous visits in the last 10 days, where she received IV fluids, paracetamol, and omeprazole, along with reassurance that the pain was musculoskeletal, it persisted ranging from mild to severe, prompting her return.
Her past medical history is unremarkable, and she is a non-smoker and non-drinker. There is a family history of maternal hypertension and paternal type two diabetes, with no similar conditions or history of sudden cardiac death.
On examination, she appeared conscious, oriented, mildly dyspnoeic but not tachypnic, and anxious due to severe pain. Physical findings included normal chest auscultation, an ejection systolic murmur loudest at the left sternal border, and no abdominal abnormalities. Vital signs were as follows: Spo2 = 96% on room air, PR = 88 beats/min, BP = 120/70 mmHg, Temp = 37.9°C, RR = 22 cycles/min.