A 22-year-old woman presented at the emergency department with severe, substernal, crushing chest pain of 45 minutes duration. The patient did not have radiating pain to the arm or neck but reported radiation to back. There was no change in the type or quality of pain with position change or on inspiration.
History Within the past week, she had experienced shortness of breath, diaphoresis, nausea, and No current or past use of cocaine or other stimulants No history of chest wall trauma Patient reported having a gastrointestinal illness with emesis and diarrhea the week before developing chest discomfort. Examination Afebrile Initial HR – 66beats/min BP – 106/64 mmHg RR – 24 breaths/min SPO2 – 99% (on room air) Physical examination in the emergency room- absence of jugular venous distension On auscultation - regular heart rhythm with a physiologic, split 2 nd heart sound and no audible…
