This is the case of a 42-year-old man with chest pain with negative T waves in both III and aVF leads on the EKG (Fig. 1). The patient was admitted to our intensive care unit where he presented with a new episode of central-thoracic pain with transient ST-segment elevation in the inferior leads of the EKG (Fig. 1) and negative high-sensitivity troponin. The echocardiogram performed revealed a left ventricular ejection fraction of 58% (Appendix B; videos 1, 2, and 3) without contractility alterations. However, the study of the left ventricular (LV) longitudinal strain of the inferior side was impaired with a LV longitudinal global strain of −18% (Fig. 2). The coronary angiography performed revealed the presence of severe stenosis on theright coronary artery middle segment (Fig. 3; Appendix B; video 4) due to intramural hematoma without dissection as seen on the optical coherence tomography (Fig. 3). A stent was implanted in such artery (Appendix B; video 5) with favorable progression.

Figure 1.

Electrocardiogram of the patient in the emergency room.

Figure 2.

Patient's strain.

Figure 3.

Cardiac catheterization and Optical coherence tomography (OCT).