The Case Files: The Killer Ticker: Left Neck Pain

By Ung, Lyncean DO; Sattler, Steve DO; Segerivas, Doni Marie DO   A 50-year-old man with a history of coronary artery disease, multiple myocardial infarctions, and diabetes mellitus presented with persistent left-sided neck pain for three weeks after having an implantable cardioverter-defibrillator (ICD) placed via his left subclavian vein. His pain was described as constant, nonradiating, and 5/10 on the pain scale. There were no modifying factors. He was evaluated one week prior for the same pain, which included an electrocardiogram, chest x-ray, and measurement of cardiac markers (Troponin I, CKMB, and CPK). All results were normal.   His symptoms had worsened since his initial evaluation with a fever as high as 101°F, dysphagia, odynophagia, and increased swelling of his neck. He denied taking any medical therapy for pain. He also denied dizziness, chest pain, palpitations, dyspnea, nausea, vomiting, and leg swelling.His initial vital signs were temperature 97.4°F, heart rate of 71 bpm, respiratory rate 20 bpm, blood pressure 135/84 mm Hg, and oxygen saturation 100% on room air. His speech was clear, indicating a patent airway. There was significant swelling encompassing the angle of the left mandible and most of the left neck. There were no bruits over the left carotid artery, but he did have tenderness to palpation of his left neck. There was a left pectoral ICD with an overlying healing scar that was clean and dry without erythema or tenderness.   His ECG was norm...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research