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Chest Pain, Statins, Troponin Elevation, and Myopathy: A Diagnostic and Management Dilemma

Published:November 08, 2020DOI:https://doi.org/10.1016/j.amjmed.2020.09.053
      A 64-year-old man with known ischemic heart disease and previous myocardial infarction and stent implantation presented to the Emergency Department with bilateral arm pain and chest discomfort with mixed features. He described a dull, central sensation within the chest, which did not radiate to the neck, jaw, or back. Additionally, he had a 3-week history of fatigue and intermittent myalgias, predominantly affecting the shoulders on exertion. Cardiac risk factors included hypertension and hypercholesterolemia. There was no history of diabetes mellitus, with normal baseline renal function (creatinine 80 µmol/L, estimated glomerular filtration rate >90 mL/min/1.73 m2). Regular medications included atorvastatin, olmesartan, hydrochlorothiazide, spironolactone, and allopurinol. He was known to have mild left ventricular dysfunction with a previous transthoracic echocardiogram showing an ejection fraction of 45%. The patient has been on long-term statin therapy, but 3 weeks prior to presentation, atorvastatin 40 mg had been changed to rosuvastatin 20 mg and symptoms had begun at that time.
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