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Challenges in Clinical Electrocardiography
April 2017

Nondiagnostic ST Elevations With Chest Pain: The Subtle STEMI

Author Affiliations
  • 1Department of Internal Medicine, Olive View-UCLA Medical Center, Sylmar, California
  • 2Division of Cardiology, Department of Internal Medicine, Olive View-UCLA Medical Center, Sylmar, California
  • 3Department of Emergency Medicine,Olive View-UCLA Medical Center, Sylmar, California
JAMA Intern Med. 2017;177(4):577-578. doi:10.1001/jamainternmed.2016.9396

A man in his 30s with a history of hypertension and occasional tobacco use presented to the emergency department (ED) with several hours of chest pain and nausea. The pain started after eating breakfast and was variably described as constant, sharp, pressurelike, and burning, but was nonexertional, nonpleuritic, and nonreproducible. An electrocardiogram (ECG) was obtained in triage (Figure 1). The first troponin I value was more than 3 times the upper limit of normal at 0.1 ng/mL (normal, ≤0.028 ng/mL [to convert to μg/L, multiply by 1.0]) but still fell within the assay indeterminate range (≤0.3 ng/mL).

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