A 70 year old man presents with acute, severe retrosternal pain radiating to the left shoulder and arm for 1 hour. His medical history is only significant for hypertension for 5 years, which is well controlled on ramipril alone. There is no history of diabetes, dyslipidemia or ischemic heart disease. He does not smoke, and is not on any drugs.
The ECG reveals the presence of left bundle branch block (LBBB); there is ST-segment elevation of 2 mm in leads V1-V3, along with concordance of the QRS complexes, T waves and ST segments.
Troponin-I: 0.1 ng/ml (normal: < 0.1)
The chest x-ray appears completely normal.
The echocardiogram reveals the presence of concentric left ventricular hypertrophy, along with focal hypokinesia of the anterior and lateral walls.