Chest Pain and Shortness of Breath in a 33-Year-Old Man

Jason Chang, MD; Linda Chun, MD


July 20, 2020

Physical Examination and Workup

Upon physical examination, the patient is a thin man who appears to be in some distress. Vital signs include a pulse of 136 beats/min, a respiratory rate of 32 breaths/min, a blood pressure of 116/82 mm Hg, and an oxygen saturation of 91% on 4 L/min via nasal cannulation. His temperature is 103.1°F (39.5°C).

The patient is diaphoretic, breathing heavily with the nasal cannula in place, and rubbing his chest. The head and neck examination findings are normal. No scleral icterus is seen. The patient's lungs are clear to auscultation; no rales or rhonchi are appreciated. He is tachycardic, with normal heart sounds appreciated. The abdomen is soft, with a well-healing wound with no rebound or guarding.

The patient is urgently placed on a cardiac monitor. He is given some intravenous morphine, which helps with the pain but does not completely resolve it.

An upright, portable anterior/posterior chest x-ray is performed, which reveals small bilateral pleural effusions and lower lobe atelectasis. Electrocardiography (ECG) reveals tachycardia (132 beats/min) and slight T-wave depressions; otherwise, no obvious differences are observed compared with his admission ECG.

His laboratory findings include slight leukocytosis of 12,000/mm3; otherwise, his complete blood cell count is within normal limits. His complete metabolic panel, troponin, and coagulation profile are within normal limits. His arterial blood gas findings are normal, except for oxygen saturation at 91%. The patient undergoes CT pulmonary angiography (Figure 1).

Figure 1.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.