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JAMA Cardiology Clinical Challenge
March 10, 2021

A Middle-aged Woman With Recurrent Chest Pain With Troponin Elevation and Unobstructed Coronary Arteries

Author Affiliations
  • 1Cardiologist at the National Heart Centre Singapore, Singapore
  • 2Duke-National University of Singapore Medical School, Singapore
  • 3Queen Mary University of London, London, England
  • 4Barts Heart Centre, London, England
  • 5Yale School of Medicine, New Haven, Connecticut
  • 6European Association of Percutaneous Cardiovascular Interventions, Sophia Antipolis, France
  • 7Newham University Hospital, Barts Health National Health Services Trust, London, England
JAMA Cardiol. Published online March 10, 2021. doi:10.1001/jamacardio.2021.0116

A middle-aged woman presented with chest pain, elevated troponin-T of 1037 ng/L (normal <14 ng/L; to convert to micrograms per liter, multiply by 1), and anterior T-wave inversion on electrocardiography. She was a smoker with hypertension and kidney dysfunction, with a history of left-sided paresthesia.

Coronary angiography demonstrated unobstructed coronary arteries. Cardiovascular magnetic resonance (CMR) imaging revealed subendocardial midinferolateral late gadolinium enhancement with corresponding hypokinesis consistent with a partial-thickness myocardial infarction. Prolonged Holter monitoring showed no evidence of atrial fibrillation.

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