A 55-Year-Old Man with 3 Hours of Epigastric Pain

Case

A 55-year-old man presents to urgent care with 3 hours of epigastric pain which began gradually and is constant. He has associated diaphoresis and minimal dyspnea. There is family history of hypertension and high cholesterol. Personal medical history is significant for diabetes mellitus and hypertension. The patient reports that he stopped smoking 2 years ago.

Upon exam, you find:

General: Alert, breathing comfortable, skin clammy

Lungs: CTAB

Cardiovascular: RRR, without m,r,g

Abdomen: Soft and NT, no distention, without r/r/g, no pulsatile mass

Ext: No peripheral edema, pulses are 2+ and equal in all extremities

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