Case 26: Chest Pain in the Middle of the night

MBBS
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1

A 45-year-old man presents with squeezing retrosternal chest pain occurring at rest around 2–3 AM. ECG shows transient ST-segment elevations. Troponins are normal.

Question:
Which of the following is the most likely diagnosis?
A. STEMI
B. Prinzmetal angina
C. Unstable angina
D. Pericarditis

2

B. ?? Even C is possible

3

Prinzmetal angina (also called variant angina) is caused by coronary vasospasm and typically presents with chest pain at rest, often in the early morning hours.
It shows transient ST-segment elevation on ECG, but normal troponin levels distinguish it from STEMI.