Not Your Typical MI
A 46-year-old woman presented with acute substernal chest pain. The pain occurred at rest and lasted 20 minutes. It was relieved when emergency medical service gave her sublingual nitroglycerin. The physical examination revealed an anxious woman who was afebrile and normotensive. She had a normal cardiac and lung examination. The first electrocardiogram (ECG) demonstrated normal sinus rhythm with ST-T wave changes in the anterolateral and inferior leads consistent with ischemia. The first troponin I returned positive at 0.41 ng/mL. The patient was started on dual antiplatelet therapy, anticoagulation, high-dose statin therapy, and a beta-blocker.
The patient remained asymptomatic overnight; however, she developed recurrent chest pain the next morning. The second troponin I returned 6.7 ng/mL, and a repeat ECG during the chest pain episode was performed (Figure 1). The patient was then taken for urgent cardiac catheterization (Figure 2).
With regard to the diagnosis, which statement is correct?