Heart Beats: MI mimickers: Chest pain and normal coronary arteries
Donna Barto DNP, RN, CCRN

$3.95 		Nursing2013 Critical Care
March 2013 
Volume 8  Number 2
Pages 6 - 7
 
  PDF Version Available!

ABSTRACT
JM is a 30-year-old obese male with no prior cardiac history who arrives at the ED on a hot summer day complaining of substernal chest pressure. He describes the pain as a squeezing sensation that radiates to his left arm and rates it as a 7 on a pain intensity rating scale of 0 (no pain) to 10 (worst pain imaginable). The pain doesn't change in intensity with position, and JM denies illicit drug use. He has no evidence of chest wall trauma. He's pale and diaphoretic. You take his vital signs: BP, 168/98 mm Hg; pulse, 72; respirations, 16; and SpO2, 100% on room air. Lung sounds are clear bilaterally, heart sounds are normal, neck veins are flat, and he has no peripheral edema. A 12-lead ECG, obtained within 10 minutes of ED arrival, shows ST-segment elevation in leads II, III, and aVF, which may indicate an inferior wall ST-elevation myocardial infarction (STEMI) (see JM's admission ECG). A chest X-ray shows no acute infiltrates or pulmonary edema and a heart size in the upper limit of normal.JM was given 324 mg of chewable aspirin, sublingual nitroglycerin, and I.V. morphine, which reduced his pain level to a 3. Stat blood work results include a cardiac troponin I level of 29.8 ng/mL (normal range is less than 0.35 ng/mL), and creatine kinase-MB (CK-MB) of 97.9 ng/mL (normal range, 0.5 to 3.6 ng/mL).After the healthcare provider reviews JM's history, physical assessment findings, troponin level, and ECG, JM is taken to the cardiac catheterization lab. Coronary arteriography reveals normal coronary arteries. JM's ejection fraction is 60% (normal range, 55% to 70%) indicating normal left ventricular function.Serial cardiac troponin I results show a peak of 40 ng/mL before beginning a downward trend, and JM still complained of chest pain, which was relieved with I.V. morphine. His clinical picture and ECG look like an acute coronary syndrome despite normal coronary arteriography. What could be the cause of this clinical picture?ST-segment elevation doesn't always indicate

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