Incidentally Found Transient and Asymptomatic ST-Elevation: A Diagnostic Dilemma

Acute coronary syndromes (ACSs) are among the most frequent causes of hospitalization worldwide. The diagnosis of ACS is based on three main criteria: 1) chest pain; 2) electrocardiographic changes; 3) changes in markers of myocardial cytolysis. However, one or more of these features are not infrequently missing or confounding, making the diagnosis difficult. An example of this condition is the so-called “silent ischemia”. In this article we report a case of a 70-year-old man in whom transient and asymptomatic ST-elevation was incidentally recorded during hospitalization. The management of this “out of guidelines” case is discussed in light of the increasing epidemic of silent myocardial ischemia