An Unusual Etiology for Acute Myocardial Infarction

A healthy 44-year-old woman with no known cardiovascular risk factors and 2 prior presentations for typical chest pain presented to the Emergency Department with acute-onset chest pain of 4 hours duration. She had a 3-month history of typical angina-type chest pain and had been unable to exercise due to these symptoms. Her initial electrocardiogram revealed no acute ischemic changes. A diagnosis of acute anxiety was made and it was felt that an acute coronary syndrome was unlikely. Serial electrocardiograms, however, demonstrated dynamic ST-T changes in the anterolateral leads, and 12-hour troponin was found to be elevated at 14.2 ng/mL (normal range: 0.20-0.32).