A postpartum woman with chest pain

A woman in her 30s was admitted to the emergency department with sudden, intense chest pain for three hours that radiated to her left arm. She had no other symptoms. On examination, her a blood pressure was 140/92 mm Hg, heart rate 85 beats/min, and blood oxygen saturation 99%. Respiratory and cardiovascular examinations showed no abnormalities. The patient had no history of hypertension, hyperlipidaemia, type 2 diabetes, or coronary heart disease. She also did not smoke or consume alcohol. One week before, she had had a spontaneous vaginal delivery at term. She had two previous uncomplicated singleton pregnancies and no relevant family history. Electrocardiography (ECG) was performed, which indicated sinus rhythm with no apparent abnormalities (fig1, fig 2). Blood tests showed a noticeably raised troponin I (TNI) level (20 ng/mL; reference range 0-0.40 ng/mL) and raised levels of D-dimer (2.8 µg/mL; reference range 0-1.00 µg/mL) and B-type natriuretic peptide (211 ng/mL; reference range 0-100 ng/mL). A chest x ray indicated no abnormalities. Echocardiography was performed and showed mild enlargement of the …