Schamroth Colin
A 22 year old highly trained sportsman presented to the emergency room with chest pain associated with sweating and pain down the left arm. He had presented to the same ER the previous day with non-specific symptoms and nausea, but felt better after bringing up bile stained fluid. The ECG taken the previous day was reported as being normal and he was sent home after an hs-Troponin T of <5 ng/ml was obtained. The ECG on the second occasion showed an evolved inferior wall infarction with posterior wall extension. Repeat cardiac enzymes now showed an elevated hs-Troponin T of 4345 ng/ml and a CK of 1227 U/L. He was taken to the CCU and treated as an acute coronary syndrome. Subsequent coronary angiography showed smooth-walled coronary arteries with the left coronary system being totally patent. The right coronary artery showed filling defects suggestive of residual thrombus in the lumen.
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