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Seen in the ED: Elevated Troponin


The patient is a young man who presents after resolution of several hours of chest pain. He is recovering from a lower GI illness and still taking Cipro. What's your Dx?

History of present illness

A man in his early thirties presents to the hospital emergency department for an episode of chest pain lasting several hours. He states he has had a diarrheal illness with high fevers for about a week which is being treated with Cipro, which he last took last night. This morning he had severe pressure across his chest that woke him but is now gone. He denies any vomiting, abdominal pain, SOB, or other complaints.

Vital signs & physical examination

Vital signs are normal except for a temperature of 102.9°F and pulse of 97 beats/min (normal range, 50-90 beat/min). Physical exam is otherwise normal.

Initial diagnostic testing

  • CBC and BMP: normal
  • ECG: normal
  • Troponin: elevated at 1.5 ng/mL and on repeat it is 2.4 ng/mL

What is the most likely diagnosis?

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