Never Too Young to Have a Heart Attack

​BY MELINDA HUANG, DO; CATHERINE KELLY, DO; & STEVEN SATTLER, DOA 36-year-old man presented to the emergency department with chest pain that had begun 30 minutes earlier. The patient was a mechanic, and said he was working on his car when he developed sharp, constant, mid-sternal, 5/10 chest pain that radiated to his left arm. He had associated nausea and dyspnea. The patient denied fever, cough, recent travel, recent surgery, malignancy, blood clots, hormone use, calf pain, and calf swelling. He did not take any medication for the pain. He denied smoking cigarettes, and had no family history of cardiac disease.The patient appeared well-developed, well-nourished, and not in acute distress on exam. He was not diaphoretic. His vital signs were an oral temperature of 97.4°F, a pulse of 45 bpm, respiratory rate of 18 bpm, a blood pressure of 106/73 mm Hg, and 100% oxygen saturation on room air. His body mass index was 25.63 kg/m2. The patient was awake, alert, and oriented. Cardiac exam revealed bradycardia with a regular rhythm and normal heart sounds. The patient was not in acute respiratory distress. He had clear lung sounds bilaterally with normal effort. His abdomen was soft, nondistended, and nontender. His legs were not edematous, and his calf was not tender to palpation.His initial ECG showed sinus rhythm at approximately 50 bpm with 1 mm ST elevation in lead III, 0.5 mm ST elevation in lead II with reciprocal changes of 1 mm ST depressions in V1-V4 and leads I and...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research