Coronary dissection in a XXXX with essential @entity1148 .

@entity1 @entity662 @entity455 @entity1148 @entity2299 @entity1353 @entity4407 @entity1163 @entity4016 @entity381 @entity158 @entity453
A 50-year-old @entity1 was admitted to the hospital with left shoulder and arm discomfort. He had no recent history of change in his energy level, limitations to activity, exertional @entity662 , or @entity1353 . He had cardiac risk factors, including a strong family history of pre-mature @entity453 and @entity2299 . He had a @entity1163 in 2003 with a positive troponin I, but had a negative cardiac workup, including cardiac catheterization that showed luminal irregularities and no significant @entity453 . An echocardiogram was performed to rule out potential cardiac causes for shoulder @entity158 and showed regional wall motion abnormalities. Follow-up cardiac catheterization revealed left anterior descending artery proximal and mid dissection and a long area of dissection in the first diagonal branch. Laboratory evaluation showed significant platelet elevation and positive @entity4016 study. Ultrasound of the abdomen revealed moderate @entity381 . The enlarged spleen, positive @entity4016 study, and persistently elevated platelet count confirmed the diagnosis of @entity4407 . @entity4407 can predispose individuals to @entity455 and damage, which may contribute to @entity453 . With this case, we propose that @entity4407 should be excluded in the presence of coronary dissection and @entity1148 .
