Total Proximal Left Anterior Descending Artery Occlusion Presenting as Right Sided Chest Pain with a Misdiagnosis of Costochondritis: A Case Report

Authors

  • Khuzeima Khanbhai Jakaya Kikwete Cardiac Institute
  • Reuben Mutagaywa Muhimbili University of Health and Allied Sciences
  • Sarah S. Matuja Catholic University of Health and Allied Sciences
  • Zalha Nuhu Muhimbili University of Health and Allied Sciences
  • Reinhard Lema Muhimbili University of Health and Allied Sciences
  • Frederick Lyimo Muhimbili National Hospital
  • Regan V. Massawe Jakaya Kikwete Cardiac Institute
  • George Longopa Jakaya Kikwete Cardiac Institute
  • Yona Gandye Jakaya Kikwete Cardiac Institute
  • Tulizo Shemu Jakaya Kikwete Cardiac Institute
  • Tatizo Waane Jakaya Kikwete Cardiac Institute
  • Peter Kisenge Jakaya Kikwete Cardiac Institute
  • Polycarp France Jakaya Kikwete Cardiac Institute
  • Kulindwa Kasubi Jakaya Kikwete Cardiac Institute
  • Emmanuel Epapfra Jakaya Kikwete Cardiac Institute
  • Faraji Lydenge Jakaya Kikwete Cardiac Institute
  • Naizihijwa Majani Jakaya Kikwete Cardiac Institute
  • Mohamed Janabi Jakaya Kikwete Cardiac Institute

DOI:

https://doi.org/10.4314/tmj.v32i3.463

Keywords:

Proximal left anterior descending artery occlusion, Acute coronary syndrome, Unstable angina, Costochondritis, Coronary computed tomography

Abstract

Background

Acute coronary syndrome refers to a group of clinical symptoms consistent with acute myocardial ischemia or infarction that are potentially life threating requiring immediate interventions. Certain proportion of patients can present with atypical symptoms leading to a missed diagnosis associated with devastating outcomes.

Case presentation

We present a 60 years’ female of African descent with a medical history of hypertension and type 2 Diabetes mellitus who presented with a 2 months’ history of right-sided anterior chest pain and was diagnosed with costochondritis. Further assessment revealed, normal cardiac markers and an electrocardiogram suggestive of anterior wall myocardial infarction. A coronary computed tomography and cardiac magnetic imaging scans revealed a total occlusion of the proximal left anterior descending artery and a viable myocardium respectively. She underwent successful percutaneous coronary interventions with stenting with complete alleviation of her chest pain.

 Conclusions

This case report highlights the importance of having a high index of suspicion in high-risk groups such as older females with co-morbidities presenting with atypical symptoms suggestive of acute coronary syndrome to health care providers. This ensures early diagnosis and provision of appropriate treatment associated with good outcomes. Likewise, the case also advocates on the use of advanced cardiac imaging in patients with inconclusive electrocardiographic and biochemical tests.

Author Biographies

Khuzeima Khanbhai, Jakaya Kikwete Cardiac Institute

Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania | Department of Internal Medicine, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

Reuben Mutagaywa, Muhimbili University of Health and Allied Sciences

Department of Internal Medicine, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania | Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania

Sarah S. Matuja, Catholic University of Health and Allied Sciences

Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania

Zalha Nuhu, Muhimbili University of Health and Allied Sciences

Department of Internal Medicine, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

Reinhard Lema, Muhimbili University of Health and Allied Sciences

Department of Internal Medicine, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

Frederick Lyimo, Muhimbili National Hospital

Department of Radiology, Muhimbili National Hospital, Dar es Salaam, Tanzania

Regan V. Massawe, Jakaya Kikwete Cardiac Institute

Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania

George Longopa, Jakaya Kikwete Cardiac Institute

Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania

Yona Gandye, Jakaya Kikwete Cardiac Institute

Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania

Tulizo Shemu, Jakaya Kikwete Cardiac Institute

Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania

Tatizo Waane, Jakaya Kikwete Cardiac Institute

Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania

Peter Kisenge, Jakaya Kikwete Cardiac Institute

Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania

Polycarp France, Jakaya Kikwete Cardiac Institute

Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania

Kulindwa Kasubi, Jakaya Kikwete Cardiac Institute

Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania

Emmanuel Epapfra, Jakaya Kikwete Cardiac Institute

Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania

Faraji Lydenge, Jakaya Kikwete Cardiac Institute

Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania

Naizihijwa Majani, Jakaya Kikwete Cardiac Institute

Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania

Mohamed Janabi, Jakaya Kikwete Cardiac Institute

Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania

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Published

2021-07-29

Issue

Section

Case Reports