Chamber Abnormalities: Pathologic or Not?

A 27-year-old male with no reported medical history presents with chest pain. He relays  several weeks of intermittent symptoms which started after lifting heavy boxes. The pain is sharp, located in the mid-chest and is otherwise non-tearing, non-pleuritic, non-positional and not associated with exertion.

On examination, the patient is in no acute distress, and appears lean without cachexia or wasting. The pain is reproduced with shoulder extension. It resolves with acetaminophen.              

View the ECG taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

27-year-old with chest pain
(Case presented by Tom Fadial, MD, McGovern Medical School, Department of Emergency Medicine, The University of Texas Health Sciences Center of Houston.)
A 27-Year-Old Male with Chest Pain and No Reported Medical History
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