Chief complaint of chest ...

A 41-year-old lady presented to the hospital with a chief complaint of chest pain. The pain started two hours before the presentation, was dull, substernal and radiated to her left arm with a severity of 7/10. She has a past medical record significant for dysfunctional uterine bleeding and was started on oral contraceptive pills (OCP). The patient has no essential past medical history, and her other vitals were normal. However, her social history is significant for smoking 1/2 a pack per day for ten years. 

Upon examination, a twelve-lead ECG revealed 1 mm ST elevations in inferior leads along with no reciprocal changes and a sinus rhythm rate of 60 beats/minute, as shown in figure (left). Her workup was significant for troponin elevation and an electrocardiogram showing inferior ST elevations. A coronary angiogram revealed a coronary thrombus involving the distal left main and proximal left anterior descending (LAD) as shown in figure (right) with no evidence of atherosclerotic disease. The patient subsequently received anticoagulation therapy leading to complete resolution of symptoms and ST elevations.