CASE 2

Name: Max Harris Sex: M Age: 45y

cc: Chest Pain

HPI: 45 year old male presents with a dull chest pain on the left side with no radiations since the past
30 mins. The intensity is described at 6 and the pain started while the patient was running to catch a
bus and it has gotten worse since it started. Nothing seems to alleviate it while movement or laying
supine makes it worse. Patient also reports dyspnea, orthopnea , palpitations while playing, fever
and a previous URI in the form of a runny nose 2 weeks ago. He was tackled while playing football 1
day before. There are no other pains, dizziness, nausea or edema.

PMH:
 No previous episodes
 NKDA
 Chronic Medical Conditions:
o Hypertension
o Hyperlipidemia/ Hypercholesterolemia

 Medications:
o Multivitamins
o Anti-hypertensives (starts with “A” or “R”)
o Medication for hypercholesterolemia (starts with “A” or “R”)
 No History of Hospitalization or Past Surgery
 GI/GU: Normal
 Sleep: Normal
 Fx: No history of any risk factors
 Social:
o Smoker: 15 pack years
o No alcohol consumption
o Usage of amphetamine twice a week for 5y, took 1 pill yesterday
o Lifestyle: Bartender, Runs once a week, Lives alone, no dietary restrictions
o No recent Travels
 Sexually active, uses protection

Physical Examination:

Vitals:
Temp: 37.9 C
BP: 135/75 mmHg
HR: 100/min
RR: 20/min

- General appearance: Alert & oriented (x3), fatigued, short of breath

- HEENT: No visible central cyanosis, no conjunctival palor, no visible rashes
- Neck: No JV distention, No lymphadenopathy, no carotid murmur.
- Cardiovascular: Regular rate and rhythm, PMI not displaced, S1 and S2 normal, No additional
heart sounds, and no hepatojugular reflux
 - Lungs: No wheezing, normal breath sounds at bilateral lung bases
- Abdomen: No palpable abdominal impulses, no renal or abdominal aortic bruits
- Extremities: No signs of cyanosis or clubbing, no edema, Peripheral pulses (Radial, DP, TP)
bilateral 2+, CRP 2 secs.

DDx: Tests:
Angina ECG
Pericarditis Echocardiogram
Musculoskeletal Stress test
Amphetamine induced CAD