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A 43-Year-Old Man Presenting With Severe Chest PainA 43-Year-Old Man Presents With Severe Chest Pain

Pablo Blanco, MD
Author and Funding Information

From the Intensive Care Unit, Hospital Dr Emilio Ferreyra, Necochea, Argentina.

CORRESPONDENCE TO: Pablo Blanco, MD, Intensive Care Unit, Hospital Dr Emilio Ferreyra, 4801, 59 St, Necochea 7630, Argentina; e-mail: ohtusabes@gmail.com


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(3):e76-e79. doi:10.1378/chest.14-2623
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Extract

A 43-year-old man was brought to the ED with chest pain that had evolved for the previous 2 hours. His personal medical history revealed poorly controlled arterial hypertension and active smoking. Family history highlights included his father’s sudden death at age 40 years.

On presentation, the patient’s vital signs were a regular heart rate at 80/min, BP of 220/120 mm Hg, respiratory rate of 24/min, and temperature of 36°C. Pulse oximetry saturation was 95% on room air. The physical examination revealed a lucid but uncomfortable and poorly cooperative patient. He stated that the pain originated in the precordium but later radiated to the interscapular area. Pain was severe from the beginning; it was not accompanied by nausea, vomiting, or diaphoresis and did not reproduce with palpation. He looked pale but well perfused; a high-intensity second sound was heard on cardiac auscultation, and no murmurs were noted. Central and peripheral pulses were present and symmetric. Respiratory examination indicated clear lung fields. ECG showed regular sinus rhythm at 80/min. No Q waves, ST-segment deviation, or negative T waves were noted. High-voltage QRS complexes compatible with left ventricle (LV) hypertrophy were seen. A medical ICU consultation was called. After initial history, physical examination, and ECG review, bedside ultrasound (transthoracic echocardiogram [TTE]) was performed to evaluate the etiology of chest pain (Video 1).

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Video 1

Running Time: 1:39

Video 2

Video 3

Running Time: 8:04

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