Case 413 -- A 12 year-old boy presented with substernal chest pain

Contributed by Kenichi Tamama, MD, PhD and Mohamed A. Virji, MD, PhD
Published on line in January, 2005


12 year-old boy without significant past medical history presented with substernal chest pain. He was diagnosed to have left lower lobe pneumonia and was receiving oral antibiotics for 2 days prior to this referral. His chest pain subsided after albuterol nebulizer treatment in a local hospital, but he was found to have elevations of cardiac troponin I (cTnI) and creatine kinase (CK)-MB with ST changes on electrocardiogram (ECG), and was referred for further evaluation.

In summary, 12 year-old boy presented with chest pain with elevations of troponin and CKMB, and ST changes on ECG. These findings are consistent with acute myocardial infarction. But, the diagnostic challenge was to determine if the elevations in cardiac markers for ischemic heart damage did represent myocardial infarction in this very young patient, or whether the pattern indicated other cause for the increase in the markers.


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