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Acute troponin elevation and the classification of myocardial infarction.

A52-year-oldwomanwith a history of hypertension presented to the emergency department with chest pain that started while sitting at work 2 hours previously. She described the pain as “someone sitting on her chest” and reported associated diaphoresis and shortness of breath. She reported nonadherence to bloodpressuremedications. Onphysical examination, the heart rate was 99 beats per minute and blood pressure was 247/130mmHg. An electrocardiogram showed sinus rhythm with left ventricular hypertrophy (LVH) and inferior T-wave inversion. Laboratory values are shown in Table 1. AnechocardiogramshowedmoderateLVHwithpreserved left ventricular systolic function and no segmental wall motion abnormalities. The following day she underwent coronary angiography,which revealed onlymild nonobstructive coronary artery diseasewith a 20% stenosis of the proximal left circumflex coronary artery.