A 39-year-old male with past medical history of
hypothyroidism, hyperlipidemia and asthma presented to our emergency room with
sub-sternal crushing type of chest pain. The pain was ongoing for the past
hour, present at rest, 8/10 in intensity, non-radiating and was not relieved by
sublingual nitroglycerine. Two days prior to presentation, the patient had flu
like symptoms with low-grade fever, myalgia, sore throat
and nasal congestion. He was a non-smoker and denied any illicit drug
abuse. The patient had no significant family history. The patient’s home
medications included inhaled fluticasone-salmeterol, simvastatin, levothyroxine
and testosterone injection 200 mg IM once every 2 weeks, which he had been
taking for 6 months.
In the emergency room, he was afebrile and his vital signs
were stable. Cardiovascular and respiratory examination was normal. His initial
EKG showed 1 mm ST elevations in lead I and aVL with reciprocal ST depressions
in lead III and aVF (Figure 1). His initial troponin was 2.08, which later
peaked to 40, and his initial CKMB value was 26.6, which later peaked to 77.6.
His chest radiograph was normal.
Patient was initially given aspirin 325 mg, clopidogrel 300
mg and was started on IV heparin drip at 1000 units/hour after a bolus of 5000
units. Subsequently, the patient underwent coronary catheterization, which
showed normal coronaries with no occlusion. A transthoracic echocardiogram
showed 50-55% ejection fraction with mild hypokinesis of the mid anteroseptal
wall.
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