Chest Pain, Diaphoresis, and Nausea

Abstract

A 68-year-old male presents to the emergency room with a 4 hour history of severe chest discomfort, cold sweats, and nausea. The pain is described as heavy pressure over the entire chest and is 9/10 in intensity. He is mildly short of breath and states that the pain is radiating to his neck. He denies any back pain at this time. He has noted reduced exercise tolerance over the past few months, however, only being able to walk for ½ block before having to stop to catch his breath. He is able to lie flat without any shortness of breath. He smokes about one pack of cigarettes per day and was recently diagnosed with diabetes mellitus and hypertension. He denies a history of cardiac events and stroke. Physical examination reveals a blood pressure of 144/78 mmHg, heart rate of 97/min, and a respiration rate of 28/min. Breath sounds are equal without crackles. Cardiac examination reveals a regular rate without murmurs and an S4. An ECG was obtained which shows sinus rhythm with ST segment elevation in V2, V3, and V4. A stat troponin is ordered and returns above normal range. Chest x-ray is normal.