Cardiology Case Report: Armpit Pain

Author(s):

This cardiology case report from Brady Pregerson, MD, features a man in his early 60s with no known medical history presenting with chest pain radiating to both armpits and anterior neck, but not to the back. How would you react?

History:

A patient in their early-60’s with no known medical history presents to the ER with 30 minutes of chest pain radiating to his both armpits as well as to the anterior neck, but not to the back. The pain is not pleuritic but there is some dyspnea. He has had about 6 episodes in the past 3 days but this one is more severe and lasting longer. He does not use tobacco but does smoke marijuana; other than that he has no modifiable risk factors for CAD. He denies any known family history of early CAD or of PE.

Exam:

Vital signs are normal. The physical exam is normal with symmetric pulses x 4

An ECG is done

ECG computer readout of a person experiencing a heart attack. | Credit: Bardy Pregerson, MD

Computer Read: NSR at 83, ST depression consider subendocardial injury
Credit: Bardy Pregerson, MD

What should you do next?