A 60-Year-Old Man With Diabetes and Hypertension

Abhimanyu Beri, MD; Fadi Abu-Yasin, MD

Disclosures

September 19, 2017

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 60-year-old man with a history of diabetes mellitus and hypertension presents to the emergency department with a 1-day history of retrosternal chest pain. The chest pain began while he had been resting and continued to worsen over the next few hours. He describes it as a sharp pain that is moderate in intensity, with radiation to his right shoulder and neck. The pain worsens when he is lying down and with deep breathing, but it is relieved by bending forward. He denies having shortness of breath or palpitations.

The patient has a medical history of hypertension, diabetes, hypercholesterolemia, and adenocarcinoma of the prostate. In addition, the day before the symptoms occurred, he was diagnosed with costochondritis during a visit to his family doctor. Review of his systems is significant only for a recent respiratory infection that had improved approximately 2 weeks before presentation. His medications include enalapril, hydrochlorothiazide, metformin, and a statin. He has smoked one pack of cigarettes a day for the past 20 years. The patient's family history is significant for premature coronary artery disease in two of his brothers.

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