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).
Wei M, Sanchez DR, Rokos I. Nondiagnostic ST Elevations With Chest Pain: The Subtle STEMI. JAMA Intern Med. 2017;177(4):577–578. doi:10.1001/jamainternmed.2016.9396
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