A 62-year-old female presented with 12 hours of crushing chest pain. Her physical exam revealed a blood pressure of 140/90, a heart rate of 110, and a respiratory rate of 16. An electrocardiogram revealed left ventricular hypertrophy with strain. Review of the chest x-ray in the emergency department (ED) revealed no abnormalities. The patient was treated for an acute coronary syndrome (ACS) with heparin, aspirin, morphine, and a nitroglycerin drip. Cardiac enzymes were drawn.
She was admitted to the cardiac care unit (CCU). Seven hours after admission, the patient became hypotensive, with a systolic blood pressure in the 80s and a heart rate in the 120s. A repeat electrocardiogram revealed no significant changes. Right-sided leads showed no evidence of right ventricular infarct. The first set of cardiac enzymes was equivocal, and a CPK-MB was minimally elevated. What can be the reason…
