Diagnosis of Acute Myocardial Infarction on Computed Tomography Angiogram

A 68-year-old white man, an active smoker with hypertension and hyperlipidemia, presented to the emergency department with substernal chest pain. His chest pain began acutely 2 hours earlier, was described as intense pressure radiating to the back, 10/10 in severity with associated diaphoresis, nausea, and vomiting. Chest pain persisted despite sublingual nitroglycerin and subsequent intravenous nitroglycerin and morphine. He remained hemodynamically stable, and the results of his clinical examination were unremarkable. His initial ECG demonstrated nonspecific ST-segment changes (Figure 1). Serial ECGs remained unchanged; a posterior ECG was not performed. Initial cardiac enzymes were also nondiagnostic. …