A 28-year-old male with a history of ADHD presents with two weeks of worsening intermittent chest pain. He describes his pain as a sharp, shooting pain that radiates to his left arm and into his left jaw. When he has the pain, he becomes diaphoretic and short of breath. These episodes last for about ten minutes; they are not provoked by activity and occur at random, even when he is at rest. Over the last two weeks, the frequency of pain as well as the intensity have increased until this morning, at which point he became concerned that it was something more severe. He believes that his grandfather died of a “heart attack” in his late 30s. He denies drug use other than prescribed Ritalin for ADHD, but admits to smoking a pack of cigarettes a day.
His initial vital signs are remarkable only for a heart rate of 100. His physical exam is unremarkable.
His initial EKG is shown below:
The patient’s initial lab workup was remarkable for a troponin of 0.05.
What caused this patient’s chest pain?
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