A 27-year-old woman who has been training for a marathon presents to the urgent care center with epigastric pain. She states the pain is worse after she consumes tomato sauce or orange juice, and wonders if she may have reflux. She denies shortness of breath, exertional component, pleuritic pain, leg swelling, use of hormonal therapy, or sweating. No right upper quadrant pain. Improves with antacids. No FH or heart disease or other risk factors.

Upon exam, you find:

General: A&O, NAD, conversational and interactive. Normal body habitus

Lungs: Clear bilaterally

Cardiovascular: Regular rhythm, without m,r,g

Abdomen: Soft with very minimal tenderness epigastric but elsewhere soft and NT, no distention, without r/r/g

Ext: No edema or asymmetry, pulses are 2+ and equal in all extremities, no pain with palpation

An ECG is performed before you evaluate the patient. Review the ECG and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

A 27-Year-Old Marathon Runner with Epigastric Pain
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