Dull Chest Pain in a 42-Year-Old Man

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

Disclosures

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.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
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.

processing....