A Case of Mistaken Identity
A 33 year-old gentleman presented to the pericardial diseases center with chest pain. Eight years prior to presentation, he was hospitalized with pneumonia and chest pain. An electrocardiogram (ECG) was performed at that time and reportedly showed diffuse ST segment elevations. He was diagnosed with pericarditis and started on colchicine and nonsteroidal anti-inflammatory drugs (NSAIDs). Over the years, he also received many courses of steroids. None of these treatments provided relief of chest pain which was described as left-sided, axillary in location, and worse with raising the left arm above his head. The pain is associated with attendant left arm tingling and numbness extending to the hand. In contrast, there is no relationship to exertion or other changes in body positions. Laboratory testing revealed normal erythrocyte sedimentation rate and ultrasensitive C-reactive protein (CRP). Transthoracic echocardiogram (TTE) was normal, without any pericardial effusion or thickening. The ECG obtained in clinic is seen below.
This patient's symptoms and diagnostic findings are most suggestive of which of the following diagnoses?