Coronary Artery Disease USMLE Step 1 Practice Question
A 48-year-old woman with hypercholesterolemia and no other cardiac risk factors presents to the emergency department with acute-onset severe substernal chest pain and dyspnea. Vital signs show BP 148/92 mmHg, HR 102 bpm, RR 18/min. Troponin I is 0.02 ng/mL (upper limit of normal 0.04). Serial ECG obtained 10 minutes apart shows transient ST-segment elevation in leads II, III, and aVF that completely resolves on the second tracing. Coronary angiography performed emergently reveals normal-appearing coronary arteries with TIMI 3 flow throughout, without atherosclerotic disease or dissection. Which of the following is the most likely diagnosis?
Answer choices
- ASpontaneous coronary artery dissection (SCAD)
- BAcute myocardial infarction with complete spontaneous thrombolysis
- CTakotsubo (stress) cardiomyopathy
- DCoronary vasospasm (Prinzmetal's angina)Correct answer
- EMyocarditis with concurrent coronary artery spasm
- FAortic dissection extending into coronary ostia
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