A 33-year-old man with atypical chest pain

Clinical introduction A 33-year-old man with no history of coronary artery disease presented to the rapid access cardiology clinic with an episode of atypical anginal chest pain. He had a 15 pack-year history of smoking and a family history of myocardial infarction under the age of 55. Physical examination and exercise ECG testing were unremarkable. On assessment in the cardiology clinic, blood sampling was notable for an elevated high-sensitivity troponin I of 61 ng/L (99% upper reference level, 34 ng/L). A coronary CT angiogram was performed (figure 1). Question Which of the following best explains this presentation? Myocarditis Myocardial bridging Kawasaki9s disease Atherosclerotic plaque rupture Eosinophilic coronary monoarteritis