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.