Troponin-Positive Chest Pain with Unobstructed Coronary Arteries

Abstract

We present a 29-year-old man who presented with crushing substernal chest pain with radiation to his jaw and associated diaphoresis. He was hemodynamically stable and electrocardiogram was unremarkable. Laboratory studies revealed initial high-sensitivity troponin of 1950 ng/L (reference: [less than]15 ng/L), 2-hour troponin 2165 ng/L, and 6-hour troponin 2413 ng/L. NT-pro-BNP was elevated at 1692 pg/mL (reference: [less than]51 pg/mL), and C-reactive protein was 50.9 mg/L (reference: [less than]8 mg/L). Transthoracic echocardiogram revealed an ejection fraction (EF) of 30[percent] with severe global left ventricular hypokinesia. Left heart catheterization revealed normal coronary arteries. Cardiac magnetic resonance imaging showed acute myocarditis. With aggressive diuresis and anti-inflammatory therapy for concomitant pericarditis, his symptoms improved. After one month of beta-blocker and angiotensin converting enzyme inhibitor therapy, his EF improved to 63[percent] with normal left ventricular function.