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History
of Present Illness
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A 63 year-old male presents to the emergency department after resolution of a 20-minute episode of chest pain, which began while he was raking leaves. The pain was described as a "pressure" sensation. The pain radiated down his arms and into his jaw and was associated with palpitations and dyspnea. The pain resolved shortly after resting. The patient had 3 prior episodes of similar pain today, lasting approximately 10 minutes each, and all with activity. He denies nausea, vomiting, diaphoresis, cough or any other associated complaints, nor is there change in the pain with inspiration or movement. He has had no recent illnesses. His past medical history is significant for diet controlled diabetes and hypertension. He hasn't smoked in "many years" and denies drug use. He presently takes HCTZ and states that he is compliant. Family history is significant for a sister who had an acute MI at age 55. He has no known allergies.
On physical examination he is an anxious, thin male who looks appropriate for age. His vitals are as follows: BP 150/85, pulse is 80, respirations 24/min, room air oxygen saturation 94%, and temperature 37.3. His external jugular veins are not distended. He has basilar crackles ¼ up bilaterally and his chest is nontender to palpation. Cardiovascular exam reveals no murmurs, gallops or rubs. His abdomen is soft and non-tender. His skin is dry and pink. He has equal bounding pulses in all four extremities. The rest of his examination is unremarkable.
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While in the emergency department he says that his pain is returning.
