A 30-something woman with intermittent CP, a HEART score of 2 and a Negative CT Coronary Angiogram on the same day

This was sent by a colleague.A 34 yo woman with a history of HTN, h/o SVT s/p ablation 2006, and 5 months post-partum presented with intermittent central chest pain and SOB.  She had one episode of pain the previous night and two additional episodes early on morning the morning she presented.  Deep breaths are painful and symptoms come and go.  She had one BP that was measured at 160/120, uncertain when and what the BP was at other moments.  Home meds were labetalol and nifedipine.  There are T-wave inversions in precordial leads.  The patient is pain free, so it is quite possible that these are Wellens ' waves. I do not have her previous ECGs, but reportedly these T-wave inversions were not present previously. Her initial cTnI returned at 0.25 ng/mL  This single initial troponin at this level, in the context of chest pain, is high enough to be diagnostic of acute myocardial infarction.  Given that there was such a high blood pressure, it is possible that this is a type 2 MI (supply demand mismatch due to high oxygen demand when myocardium is pumping against such elevated blood pressure.)At this point, with the information above, the patient ' s overall clinical picture could be consistent with either reperfused OMI, or Non-OMI, since both may have absent pain and inverted T waves.Another ECG was recorded a bit later (exact time unknown):The T-waves are deepening, consistent with Wellens ' or even poss...
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