Case history/examination
A 46 years old woman was admitted to our emergency room on September 21st 2021, with acute onset chest pain which was retrosternal and radiating to the left arm and between two shoulders with a feeling of heaviness in the chest. The pain had a continuous nature from two hours before admission. In addition, she mentioned nausea, vomiting and cold sweat. The patient was nonsmoker and had a past medical history of stage 1 hypertension based on ACC/AHA 2021 hypertension guidelines for about three years and hyperlipidemia. She was under a single-drug treatment with a daily dosage of 25 mg of losartan tablet for hypertension and was under control. She was also affected by COVID-19 three weeks ago and underwent outpatient treatment with remdesevir for five days during which the patient didn’t experience fluctuations in blood pressure.
On physical examination, a systolic blood pressure difference of 40 mmHg between arms (140/80 mmHg in right arm versus 100/80 mmHg in left arm) was detected by sphygmomanometer in the assessment of vital signs. Her heart rate was 82 beats per minute. Respiratory rate was 16 per minute and arterial O2 saturation was 96%. Pulmonary and heart auscultation were unremarkable. A discrepant pulse between left and right radial artery was felt which the left radial pulse was weaker. Routine neurological examination was normal, and the power in all limbs was 5/5, with a Glasgow coma scale of 15/15. Pupils were 3 mm bilaterally equal and reactive to light, the abdomen was soft and lax with no tenderness.