Myocardial infarction without coronary arteries stenoses in a patient with Jervell and Lange-Nielsen syndrome - diagnostic dilemmas

According to the rules of differential diagnostics an acute coronary syndrome (ACS) often constitutes an initial diagnosis while a subsequent patient's follow-up with troponin determination results in further verification of the diagnosis. A 55 year-old female with congenital hearing loss, poorly controlled hypertension, type 2 diabetes treated with oral medications, and hypothyreosis was admitted to the Department of Cardiology with 6 h long severe chest pain radiating over her back with concomitant dyspnea. She underwent urgent coronary angiography which showed no epicardial coronary narrowing. Acute heart failure symptoms occurred immediately after coronary angiography in the form of cardiogenic shock. Even though an ACS was diagnosed on the basis of typical biochemical, electrocardiographic and clinical criteria, a further follow-up suggested a possibility of a co-existance of other diseases which occurred to be a Jervell and Lange-Nielsen syndrome.