Introduction:

Cardiac causes of chest pain in children and adolescents are uncommon but potentially serious. Coronary artery anomalies account for 2.2% of congenital heart diseases.

Objective:

To describe a clinical case of chest pain of cardiac origin, with emphasis on the diagnostic process.

Case report:

A 13-year-old male presented with exertional syncope and functional class II–III angina of three months’ evolution during physical activity. He sought medical attention after a syncopal episode during a football match. Simultaneously, he experienced very intense, oppressive chest pain involving the entire precordial area, without radiation. Physical examination: normal. Electrocardiogram: ST-segment depression in leads DI, DII, and V2–V6. Troponin test: negative. Chest X-ray and echocardiogram: normal. Intravenous morphine, transdermal nitrates, acetylsalicylic acid, and enoxaparin were initiated. One hour later, ECG: ST-segment normalization. At 12 hours: qualitative troponin test positive. Cardiac enzyme panel: CPK 965 U/L and CPK-MB 67. Coronary angiography: anomalous origin of the left coronary trunk. CT angiography: the left coronary trunk originated from the right coronary sinus, with an intramural and interarterial course. A neo-ostium of the left coronary artery was created by fixing the endothelium to the vessel wall. Outcome: favourable.

Discussion:

It is essential that healthcare professionals involved in the care of children and adolescents be familiar with the key aspects of history-taking and physical examination in order to adequately detect congenital and acquired heart diseases in accordance with current guidelines. This contributes to early diagnosis and timely treatment of these conditions and can significantly alter the prognosis, as was the case in the present report.

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