Case 18-1986 — A 44-Year-Old Woman with Substernal Pain and Pulmonary Edema after Severe Emotional Stress

Presentation of CaseA 44-year-old woman was admitted to the hospital because of chest pain.She was well until the afternoon before admission, when she was informed that her 17-year-old son had committed suicide by hanging earlier in the day. Half an hour later severe "crushing" substernal pain developed, with radiation to the left shoulder. The pain persisted and worsened, and after six hours she was taken to another hospital, where sublingual nitroglycerin was administered on three occasions, without relief. An electrocardiogram was reported to be unchanged from a routine tracing obtained several months earlier; Q waves were present in . . .