Constrained Heart A Case of Sudden Onset Unrelenting Chest Pain
A 43-year-old athletic black male was awoken from sleep with severe left-sided, nonradiating chest pain. He has no past medical history and denied any recent injury, infection, or drug use. He described the chest pain as nonreproducible on palpation but sharp that increased in severity when laying on his left side. Because of his symptoms the patient went to the local emergency department. On arrival, his temperature was 98.3 degrees F, pulse 79 bpm, blood pressure 170/100 mm Hg, and respiratory rate of 24 breaths per minute with oxygen saturation of 98% on room air. Physical examination revealed a jugular venous pressure of 8 cm H2O, clear lungs on auscultation, regular rate with normal S1 and S2 sounds without murmurs, rubs, or gallops. There was no lateral displacement of the point of maximum impulse. The abdomen was nondistended with normal bowel sounds and was free of bruits. The extremities were warm, with 2+ palpable pulses with no arterial pulse delay. Cardiac enzymes were drawn and an initial ECG (Figure 1) showed normal sinus rhythm with >5-mm ST-segment elevations in the lateral and inferior lead segments.
Faculty; Northwell Researcher
School of Medicine; Northwell Health