A 37-Year-Old Man with a Two-Day History of Chest Pain

The patient is a 37-year-old man who reports a two-day history of chest pain. It worsens with exertion, and when he lays back; it improves when he’s sitting or leaning forward. He denies any diaphoresis, radiation, or back pain. No pleuritic aspect. During the exam, he is alert and oriented, and in no distress. In addition, you find: Lungs: Clear to auscultation bilaterally Cardiovascular: Regular rate and rhythm without murmur, rub, or gallop Abdomen: Soft …

Read More

Young Football Player with Sudden Chest Pain

Case A 20-year-old previously healthy man presents with sudden onset of substernal chest pressure after completing football practice. His chest pain is nonradiating, nonreproducible, and nonpositional. He does not have associated palpitations, dyspnea, or diaphoresis. He reports that he has not had recent upper respiratory tract infections or contact with ill people. He does not have a history of using alcohol, tobacco, or illicit drugs. He has no family history of sudden cardiac death or …

Read More
Acute Pericarditis

Acute Pericarditis

Urgent message: This case underscores the importance of not “anchoring” to a previous provider’s diagnosis and always remembering that medical conditions are dynamic. JOHN J. KOEHLER, MD, and DANIEL MURAUSKI, DO IntroductionAcute pericarditis is defined as inflammation of the pericardium that surrounds the heart and the base of the great vessels. The classical presentation consists of chest pain, a pericardial friction rub, and serial changes on electrocardiogram (EKG). Although data on the incidence of pericarditis …

Read More

Acute Pericarditis in a 12-Year-Old Girl

M.J. is a 12-year-old African American female who presented with trouble “taking a breath” which was abrupt in onset, starting two hours prior to presenting and accompanied with abdominal pain and fatigue which resolved prior to her visit. Dyspnea was constant and not related to position. There were no alleviating or aggravating factors. Observations and Findings Patient was alert and in no distress and spoke in full sentences. Pmhx: bronchitis one year prior; no asthma, …

Read More