A 51-year-old male presents to the emergency center with chest pain. He states
that he has had chest discomfort or pressure intermittently over the last year
especially with increased activity. He describes the chest pain as a pressure
behind his breastbone that spreads to the left side of his neck. Unlike previous
episodes, he was lying down, watching television. The chest pain lasted
approximately 15 minutes then subsided on its own. He also noticed that he
was nauseated and sweating during the pain episode. He has no medical prob-
lems that he is aware of and has not been to a physician for several years. On
examination, he is in no acute distress with normal vital signs. His lungs were
clear to auscultation bilaterally, and his heart had a regular rate and rhythm
with no murmurs. An electrocardiogram (ECG) revealed ST segment elevation
and peaked T waves in leads II, III, and aVF. Serum troponin I and T levels are
What is the most likely diagnosis?
What biochemical shuttle may be active to produce more adenosine
triphosphate (ATP) per glucose molecule?