Chest pain, statins, troponin elevation and myopathy: A diagnostic and management dilemma

A 64 year old male with known ischemic heart disease and previous myocardial infarction and stent implantation presented to the Emergency Department with bilateral arm pain and chest discomfort with mixed features. He described a dull, central sensation within the chest which did not radiate to the neck, jaw or back. Additionally, he had a three week history of fatigue and intermittent myalgias, predominantly affecting the shoulders on exertion. Cardiac risk factors included hypertension and hypercholesterolemia.