Low atrial rhythm mimics myocardial infarction.

A 55-year-old male patient was admitted to an emergency department of a secondary care hospital with left forearm pain and numbness of fingers lasting for 6 h. He did not state any kind of chest pain and has not had any cardiac disease history and risk factors except smoking for 30 years. Electrocardiography (ECG) demonstrated negative P waves and ST-segment elevation in inferior leads and minimal ST-segment depression in D1 and aVL, and heart rate was 101 bpm (Fig. 1). His cardiac examination and vital signs were normal. He was transported to our hospital for primary percutaneous coronary intervention with the diagnosis of inferior myocardial infarction (MI). Which of the following is not included in your first differential diagnosis in light of the clinical and electrocardiographic findings?

Figure 1

ST-segment elevation and negative P waves in inferior leads

Which of the following could be the cause of troponin release?

Vasospastic angina

Acute coronary syndrome

Cervical disc hernia

Early repolarization

All choices should be included