A woman with retrosternal chest pain referred for pPCI

The Challengee: Dr. Alessia Gambaro, Italy

"The ACVC Acute Echo Challenge was a fantastic experience, which made me grow!

It was really interesting to see how I changed my approach and perspective during the case scenario.

In the acute setting, I excluded the most dangerous things (acute aortic syndrome, big problems with the valves) and focused on the main problem: the akinetic left ventricle and the ST elevation on the ECG. After the coronary angiography, when the situation was more stable, I looked closely at the echo images and elements I overlooked in the acute setting became more obvious.

Guided by a great mentor, Prof. Neskovic, I reached the diagnosis using the proper imaging techniques at the appropriate time."

The case

• 71-year-old woman
• Retrostenal chaest pain 3.5 hours ago, while lifting a heavy box
• Referred as STEMI for pPCI
• Two years beofre one episode of chest pain while removing snow, relieved after two hours and NSAID
• RF for CAS: smoker (for 40yrs/ 10 cigarettes per day)
• In 2015, operated on for colon adenoCa, followed by chemotherapy - no evidence of cancer recurrence
• Taking no medication
• ED: pain still present, the same intensity associated with fatigue and sweating, no propagation in arm/back/jaws