title: A 33-year-old man with atypical chest pain.
abstract: A 33-year-old man with no history of coronary artery disease presented to the rapid access cardiology clinic with an episode of atypical anginal chest pain. He had a 15 pack-year history of smoking and a family history of myocardial infarction under the age of 55. Physical examination and exercise ECG testing were unremarkable. On assessment in the cardiology clinic, blood sampling was notable for an elevated high-sensitivity troponin I of 61 ng/L (99% upper reference level, 34 ng/L). A coronary CT angiogram was performed (figure 1).
  
  
  
  Which of the following best explains this presentation? MyocarditisMyocardial bridgingKawasaki's diseaseAtherosclerotic plaque ruptureEosinophilic coronary monoarteritis.
authors.affiliation: Centre for Cardiovascular Science, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Alastair J
authors.initials: AJ
authors.lastname: Moss
authors.affiliation: Centre for Cardiovascular Science, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Dweck
authors.affiliation: Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Flapan
mesh_terms: D000328:Adult; D000787:Angina Pectoris / Q000209:etiology*; D015415:Biomarkers / Q000097:blood; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D054059:Coronary Occlusion / Q000209:etiology / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D018450:Disease Progression; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D062645:Percutaneous Coronary Intervention; D058226:Plaque, Atherosclerotic; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012422:Rupture, Spontaneous; D019210:Troponin I / Q000097:blood; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D019210:Troponin I