Our patient is a 38-year-old man with a chief complaint of substernal chest pain of several hours duration.
The pertinent features of his history include the following:
The patient’s symptoms awakened him from sleep hours ago and has persisted since then. He describes the pain as sharp, substernal and non-radiating. It is worsened with deep inspiration and lying down and is alleviated by sitting up and leaning forward.
Because his symptoms persisted, he became frightened and was driven to the emergency department by his wife.
One week ago, the patient recovered from an upper respiratory infection and has had no significant cough or sputum production.
He denies any shortness of breath, nausea or vomiting. His only medication is chronic beta-blocker therapy that he takes for occasional migraine headaches.
There is no history of previous episodes of chest pain, deep vein thrombosis, prolonged inactivity or hypertension.
He has no known risk factors for coronary artery disease or family history of heart disease.
There is no history of recent chest trauma or surgery, tuberculosis, collagen-vascular disease, malignancy, radiation therapy or risk factors for HIV. He denies any history of illicit drug use, including cocaine.