A 76-year-old female patient who consulted in a hospital emergency department due to pain in the mandibular area of three days of evolution.
After the medical examination, the patient was referred to her home with a diagnosis of "mandibulararthrosis", prescribing analgesics and advising her to the dentist.
Horses later the patient went to our consultation, where we applied the study protocol to patients with temporomandibular disorders (TMD) and as examination we practiced orthopanography.
Within the personal medical history of the patient, it should be noted that he had suffered from hypertension for 3 years and hypercholesterolemia for a year.
In the anamnesis about the temporospatial characteristics of the pain, the patient reports that she presents episodes of pain in the bilateral submandibular region of three days of evolution, which now irradiates to the precordial area and to the throat.
Pain episodes last between five and ten minutes, with a feeling of shortness of breath and accompanying sweating.
He has had three episodes this day.
This pain was resistant to the analgesics prescribed in the emergency department.
After performing the complete stoma exam, we found an opening click on the right temporomandibular joint and crepitation on the left side.
Jaundice presented crossbite and dental midline deviation.
Mandibular function was preserved with a maximum opening of 39 mm.
Orthopantomography showed signs of mild arthrosis in the left temporomandibular joint.
These findings did not justify the clinical picture of the pain presented by the patient, so we emitted the clinical diagnosis of presumptive "ischemic cardiopathy" and referred the patient, urgently, to our consultation.
The patient was admitted to the hospital and during the clinical examinations, presented again several episodes of mandibular pain.
The electrocardiogram (ECG) showed signs of growth and left ventricular systolic overload, negative T in II, III, aVF and V4 to V6.
After performing pertinent studies: blood analysis, chest X-ray, echocardiogram and diagnostic catheterization, severe lesion was found in two coronary vessels.
Angioplasty was performed and at three weeks she was discharged with a diagnosis of angina pectoris (Grade III, B1), severe lesion of two coronary vessels and double degenerative aortic lesion.
