Emergency Medicine

65 year old man presenting with chest pain

Amrit Misra on May 23, 2013

65 year old gentleman presents to the Emergency Department with a one hour history of acute onset chest pain.  He notes that he has never had this pain before and describes it as heavy, constant pressure on the left side of his chest.  He reports some shortness-of-breath and nausea with the pain as well as an URI last week, but denies any other symptoms, including abdominal pain, diarrhea, constipation, fevers, or chills.

PMHx: Hyperlipidemia

PSHx: Noncontributory

FMHx: Positive for father with coronary artery disease.

Medications: Lipitor

Allergies: None

Social: Smokes 1.5 ppd x 20 years. Infrequent alcohol use.  Denies any illicit drug use.

  • Temp  36 C
  • HR  140
  • BP  100/60
  • RR  30
  • O2  91% on Room Air

Physical Exam:

General: Uncomfortable appearing man, laying on examination table.

Heart: Tachycardic, with regular rhythm, s1 and s2 audible.  No murmurs, rubs, or gallops.

Lungs: Clear bilaterally to auscultation, with no wheezes, rales, or rhonchi audible.

Abdominal: Soft, nontender, non-distended.  No rebound tenderness or guarding.

65 year old gentleman presents to the Emergency Department with a one hour history of acute onset chest pain.  He notes that he has never had this pain before and describes it as heavy, constant pressure on the left side of his chest.  He reports some shortness-of-breath and nausea with the pain as well as an URI last week, but denies any other symptoms, including abdominal pain, diarrhea, constipation, fevers, or chills.

PMHx: Hyperlipidemia

PSHx: Noncontributory

FMHx: Positive for father with coronary artery disease.

Medications: Lipitor

Allergies: None

Social: Smokes 1.5 ppd x 20 years. Infrequent alcohol use.  Denies any illicit drug use.

  • Temp  36 C
  • HR  140
  • BP  100/60
  • RR  30
  • O2  91% on Room Air

Physical Exam:

General: Uncomfortable appearing man, laying on examination table.

Heart: Tachycardic, with regular rhythm, s1 and s2 audible.  No murmurs, rubs, or gallops.

Lungs: Clear bilaterally to auscultation, with no wheezes, rales, or rhonchi audible.

Abdominal: Soft, nontender, non-distended.  No rebound tenderness or guarding.

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