- Chia-Chen Chen, foundation doctor1,
- Jiayi Shao, foundation doctor1,
- Yuchen Liu, professor1 2,
- Yusi Gao, attending doctor, cardiologist1 3
- 1Peking University Health Science Center, Beijing, China
- 2The First Affiliated Hospital of Shenzhen University, China
- 3Department of Cardiology, Peking University First Hospital, Beijing, China
- Correspondence to Y Gao ysgaobjmu{at}126.com
A man in his 40s presented to the emergency department with a nine hour history of mild intermittent chest discomfort, palpitations, and sweating. He had a history of well controlled hypertension and a previous posterior wall myocardial infarction nine years ago (an electrocardiogram (ECG) from that time is shown in fig 1). He had not been taking his cardiac or antihypertensive medication regularly.
ECG at myocardial infarction nine years before this presentation
Initial physical examination showed his body temperature to be 36.4°C, blood pressure 126/106 mm Hg, pulse rate 95 beats/min, and respiratory rate 16 breaths/min. An ECG was obtained (fig 2). A high sensitivity cardiac troponin I assay (Beckman Coulter Access hsTnI) showed his levels to be elevated at 472.3 ng/L (99th centile for …