Case 2. A man aged 49 years with no personal
or family history of coronary artery disease was revaccinated on March 12.
On the evening of April 7, he had an episode of chest pain that he attributed
to indigestion. On April 8, while driving, he experienced increasingly severe
chest pain, dyspnea, and diaphoresis. In the emergency department, an electrocardiogram
showed nonspecific ST- and T-wave abnormalities and poor R-wave progression,
all consistent with an anterior MI. Total creatine kinase and troponin-I assays
were substantially elevated. Cardiac catheterization indicated an anterior
MI caused by complete occlusion of the left anterior descending artery. Successful
percutaneous transcoronary angioplasty and stent placement were performed,
and the patient managed with aspirin, heparin, and intravenous beta-blockers.
He is recovering at home.