Year: 2007
Type: article
Study design: Case Report
Abstract: E Mwas regular, with no murmurs or adventitial sounds.His abdomen was soft, nontender and nondistended.A rectal exam showed normal tone and brown, guaiac-negative stool.His extremities were warm and well perfused, with no oedema.He had normal strength and sensation to light touch in his extremities.He had no diaphoresis or rash.Dr. Shamai Grossman: Epigastric pain, although usually a symptom of gastrointestinal disease, has a wide differential diagnosis encompassing multiple organ systems.The differential in this case must remain broad, as the physical exam was unrevealing.It is also important to remember that pain relief with nitroglycerin is not specific to cardiac disorders and does not narrow our diagnostic possibilities [1]. Dr. Lara Kulchycki:The band-like nature of his discomfort is noteworthy and raises the possibility of radicular pain.Were there any indications of neurological disease?Dr. Pope: The neurological review of systems and gross motor and sensory exam were normal, so our initial plan was to evaluate for cardiovascular and gastrointestinal pathology.The patient was placed on a cardiac monitor and given supplemental oxygen by nasal cannula.An electrocardiogram, chest radiograph and cardiac enzymes were ordered.Because epigastric pain radiating to the back raises concerns for aortic dissection, a chest computed tomography (CT) scan with intravenous contrast was performed.Although abdominal pathology is less likely in the setting of a benign physical exam, liver function tests and pancreatic enzymes were requested.Dr. Fischer: What was your interpretation of these studies and what was the patient's subsequent clinical course in the ED?Dr. Pope: The electrocardiogram showed normal sinus rhythm at a rate of 86 beats/min with left axis deviation (Fig. 1).Complete blood count, chemistry panel and liver function
Source: Internal and Emergency Medicine
Institutions: Beth Israel Deaconess Medical Center, Harvard University
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,790
OpenAlex ID: W1981124577