Teenager with chest pain and slightly elevated troponin. What happens then?

This is a previously healthy male teenager who was awoken by chest pain.  He was seen at another hospital and found to have a slightly elevated troponin, then underwent a CT pulmonary angiogram (PE) protocol which revealed a right sided pneumonia.  He was treated with Ceftriaxone and azithromycin.p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Calibri; background-color: #fefefe}The pain is described as located in the midsternal area, radiating to the right arm, described as 8-9/10 and worse with deep inspirations.  He endorsed cough, fever, and body aches in the previous days.Here is the initial ECG:Time zero:Sinus rhythm. There is PR depression: see especially leads II and V5.The ST segment is not elevated relative to the TP segment, but it is elevated relative to the QRS onset.QRS onset is the best location for ST segment comparison, and is the location recommended by Universal Definition of MI. Why?PR depression is due to the negative atrial repolarization wave.  That wave is still resulting in J-point depression, so there should be J-point depression relative to the TP segment.But here the J-point is NOT depressed, so there is actually ST elevation.There is no reciprocal ST depression in aVL.See here for explanation of the atrial repolarization wave.This ECG is pretty typical of myopericarditis, and fits the clinical syndrome.This ECG was read initially as normal, and cardiology was not concerned.The first troponi...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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