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Myocardial infarction in a 25-year-old woman.

A 25-year-old woman presented with chest pain. Electrocardiogram (ECG) on admission was normal. When she had recurrent chest pain a second ECG showed marked ST elevation in the anteroseptal leads. Coronary angiography confirmed occlusion of the left anterior descending coronary artery. She was subsequently found to have a coagulation abnormality. The case illustrates several important points. Inquiring about risk factors in patients with chest pain should include a question about abnormal clotting. It is important to exclude significant pathology in patients who may appear 'histrionic': inspection of a patient's belongings and collateral history may be invaluable.