A 30-something with Chest pain, elevated troponin, with Subtle ST Elevation and hyperacute T-waves.

A 30-something male presented in the middle of the night with several hours of sharp, non-radiating, left sided chest pain.  It was there earlier, went away, and then returned approximately 1 hour prior to arrival. He is a smoker and has some family history of early MI.  Exam and vital signs were normal.Here was the triage ECG:There appears to be diffuse ST Elevation (II, III, aVF with reciprocal STD in aVL, V3-V6, and lead I, with T-waves that appear to be hyperacute (broad and fat, but on the other hand they have no straightening of the ST segment).  ST depression and T-wave inversion in V2 suggests posterior OMI.This is highly suggestive of acute OMI.Providers were not convinced that this was OMI, so they awaited the first troponin.  The initial high sensitivity troponin I returned 68 minutes after this ECG at 3900 ng/L (quite high, consistent with OMI, NOMI, or other etiology of acute myocardial injury).Given the young age, they were also suspicious of myocarditis, and ordered a CRP.The Cath lab was activated.  Here is the report:Cath lab activation at 3 am by the ED for atypical CP, and elevated troponin with diffuse STT changes.  No angiographically significant obstructive coronary artery disease .Peak trop at 7 hours was 4646 ng/LCRP 88 (very high)Formal Echo the next day:The estimated left ventricular ejection fraction is 49%.Cardiac MRI1) Borderline decreased LV function with small wall motion abnormality involving the apex&nbs...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs