PAINE PANCE Pearl – Emergency Medicine

57-year-old male, with controlled hypertension, presents to emergency department with a 2-hour history of a central, dull, chest pain that does not radiate.  He rates it as a 4/10 in severity and denies any aggravating or alleviating factors.  He reports some mild nausea and what he reports as “reflux” during this event as well.  He denies shortness of breath, vomiting, arm radiation, back radiation, abdominal pain, dizziness, or syncope.  His father has HTN, HLP, and had a non-fatal AMI at 62-years-old.  He is a never smoker.  His BMI is 27.3.


Vital signs show BP-122/82, HR-93, RR-16, O2-100% on room air, and temp-98.0.


Physical exam reveals:


Skin – no diaphoresis

Cardiovascular – RRR without M/G/R

Pulmonary – CTA without adventitial breath sounds

Abdomen – S/ND, mild epigastric tenderness to deep palpation

Peripheral Vascular – 2+ pulses throughout

Neuro – A&Ox3, 5/5 strength throughout


EKG is below:



Laboratory Screening:

High-sensitivity troponin (hs-cTnI) – 0.02 ng/dL

CK-MB – 39 U/L

Total CK –  264 U/L

Myoglobin – 22 ng/mL

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