AccessMedicine's Case of the Week: Chest Pain

Vanderbilt Internal Medicine and Pediatric Curriculum: Chest Pain

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Case:

A 47-year-old female with a history of obesity and osteoarthritis presents to your primary care practice for evaluation of acute chest pain. She is accompanied by her elderly mother of 86 years who you also care for and know to be of sound mind and health. The pain began today while cleaning the kitchen, is described as substernal with radiation to the left arm and neck, characterized as a "heavy" feeling on her chest, made worse with deep inspiration, improved with rest, lasted 4 to 5 minutes, and associated with nausea. There was no shortness of breath or emesis. Her mother is scared and thinks her daughter's complaints are all due to "stressful times" in the home.

Questions:

1: What imaging studies do you want to perform right now?

2: What additional history about the "stresses at home" would you like want to obtain?

3. You have completed a thorough history and exam, read a normal chest x-ray (CXR) and are now evaluating your patient's electrocardiogram (ECG). What features of the ECG prompt concern for ACS?


Click HERE to answer the questions and complete the case!

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Julie Grishaw, ACNP

Senior Editor, McGraw-Hill Education