The patient is a 44-years-old previously healthy male who presents with continuous, typical cardiac chest pain of a few hours’ duration, with no associated symptoms. He reports that this is a first-time occurrence. He also relays that he is a nonsmoker, nonalcoholic with no family history of heart disease.
On physical examination, you find his vital signs are stable. Cardiac auscultation reveals normal first and second heart sounds with no murmurs. Labs reveal slightly elevated cardiac enzymes. Other routine laboratory results are within normal ranges.
View the ECG and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page. (Case presented by Omar Al-assaf, Internal Medicine Department, Rashid Hospital, Dubai Health Authority; Muna AlJallaf, Cardiology Department, Rashid Hospital, Dubai Health Authority; and Anas Musa Emergency Department, Rashid Hospital, Dubai Health Authority.)
