Dull Chest Pain in a 42-Year-Old Man

Ryland P. Byrd, Jr, MD; Thomas M. Roy, MD


June 12, 2017

Physical Examination and Workup

The patient is alert but appears uncomfortable. He is afebrile. His blood pressure is 160/102 mm Hg in all extremities, with equal and symmetric pulses in both carotid and brachial arteries. His pulse is 103 beats/min and regular. The cardiac examination reveals an early diastolic murmur in the aortic region, with no gallop, pericardial rub, or knock; however, the heart sounds are slightly distant. The patient's lungs are clear to auscultation. The abdominal findings are unremarkable. The patient's cranial nerves are intact, and no neurologic deficits are noted.

An ECG is obtained (Figure 1). Serial cardiac isoenzyme tests demonstrate no evidence of myocardial injury. A chest radiograph is obtained (image not available).

Figure 1.


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