A 76-year-old female patient consulted a hospital emergency department for pain in the mandibular area that had been developing for three days.
After the medical examination, the patient was sent home with the diagnosis of "mandibular arthrosis" and was prescribed painkillers and recommended to see a dentist.
Hours later, the patient came to our surgery, where we applied the protocol for the study of patients with temporomandibular disorders (TMD) and, as a complementary examination, we performed an orthopantomography.
Among the patient's personal medical history, it should be noted that she had suffered from arterial hypertension for 3 years and hypercholesterolemia for a year.
In the anamnesis regarding the temporospatial characteristics of the pain, the patient reported episodes of pain in the bilateral submandibular region, of three days' duration, which now radiated to the precordial area and the throat. The episodes of pain last between five and ten minutes, with a sensation of shortness of breath and accompanying sweating. On this day he had three episodes. This pain has been resistant to the painkillers prescribed by the emergency department.
After a complete stomatological examination, we found an opening click in the right temporomandibular joint and crepitus on the left side. Occlusally there was a crossbite and deviation of the dental midline. Mandibular function was preserved with a maximum opening of 39 mm.
The orthopantomography showed signs of mild arthrosis in the left temporomandibular joint.
These findings did not justify the patient's pain, so we made a clinical diagnosis of presumed "ischaemic heart disease" and referred the patient urgently from our practice to a hospital for evaluation and treatment.
The patient was admitted to the hospital and while undergoing clinical examinations, she presented again with several episodes of jaw pain. The electrocardiogram (ECG) showed signs of enlargement and systolic overload of the left ventricle, negative T in II, III, aVF and from V4 to V6.
After performing the relevant complementary studies: blood tests, chest X-ray, echocardiogram and diagnostic catheterisation, a severe lesion was found in two coronary vessels.
Angioplasty was performed and after three weeks she was discharged with a diagnosis of unstable angina (Grade III, B1), severe lesion of two coronary vessels and double degenerative aortic lesion.
