History of Present Illness:
An man in his early 30’s with no past medical history presents for chest pain since the prior evening. He has also had a cold for about a week but most of those symptoms seem to be improving over the past 3 days. His chest pain is not pleuritic, positional or exertional and does not really radiate but is associated with numbness in both forearms, more on the left
Vital signs are normal . Physical exam is also normal with symmetric pulses, no splinting and clear lungs
An ECG is done
Computer Read: Sinus rhythm, Normal ECG
What is the most likely cause of the chest pain in this patient?
- A) ACS
- B) Pleurisy
- C) PE
- D) Dissection
- E) Pericarditis
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My ECG interpretation: These is a normal sinus rhythm with diffuse ST elevation that is concave up as well as diffuse PR depression. ST elevation appears to be more notable in lead II than lead III. There is also a soft Spodick’s sign
What is the most likely cause of the chest pain in this patient?
- A) ACS
- B) Pleurisy
- C) PE
- D) Dissection
- E) Pericarditis – CORRECT – There are multiple suggestive findings
1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook
Case conclusion: Troponin 550 with repeat of 5000. Due to rapid rise CTPA and CT coronary done, both of which were completely normal