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New-onset chest pain and palpitation
  1. Michael Y C Tsang1,
  2. Andrew D Calvin1,
  3. Guy S Reeder1,
  4. Naser M Ammash1,
  5. Julie E Hammack2,
  6. Rowlens M Melduni1
  1. 1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Rowlens M Melduni, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA;melduni.rowlens{at}

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Clinical introduction

A 71-year-old woman with no prior history of arrhythmia presented to the emergency room after experiencing a pounding discomfort in her left chest and back for 12 h. There were no symptoms or signs of overt heart failure. Her ECG showed new-onset atrial fibrillation with a ventricular rate of 122 bpm and non-specific ST-T wave changes. Laboratory investigations revealed a markedly increased serum troponin I level of 5.48 ng/mL (normal range 0–0.12 ng/mL) and a creatine kinase-myocardial band isoenzyme (CK-MB) level of 6.8 ng/mL (normal range <3.8 ng/mL). The rest of her blood work, including complete blood count, creatinine, serum glucose and thyroid-stimulating hormone, was unremarkable. Her chest X-ray did not demonstrate any evidence of pulmonary oedema. The patient's heart rate slowed following the administration of intravenous metoprolol, and she spontaneously converted back to a sinus rhythm after a few hours. Her serum troponin I level increased further to 6.86 ng/mL 8 h after her initial measurement. Due to the significant elevation in the …

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  • Contributors MYT drafted the manuscript. RMM, GSR, ADC and MYT were involved in the conception and revision of the article. All authors reviewed and gave final approval of the submitted manuscript.

  • Competing interests None.

  • Ethics approval Minnesota Research authorisation.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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