A 41-year-old man comes to the emergency department with a 2-day history of sharp chest pain that ha

Discussion in 'Step 3' started by samuel, Dec 19, 2014.

  1. samuel

    samuel New Member

    A 41-year-old man comes to the emergency department with a 2-day history of sharp chest pain that has been getting progressively worse. The pain increases when he is supine and improves when he sits upright. He has never had pain like this before and he denies dyspnea, diaphoresis, nausea,or presyncope. He does not smoke, has no chronic medical conditions, and has no family history of coronary artery disease. He is an avid jogger and was running 3-5 miles every day up until the pain began 2 days ago. Upon further questioning, you discover that he had a recent upper respiratory tract infection that resolved approximately 5 days ago. His temperature is 37.6 C (99.7 F), blood pressure is 120/82 mm Hg, pulse is 95/min, and respirations are 14/min. Physical examination shows a triphasic cardiac rub. A chest x-ray is normal and an electrocardiogram shows diffuse ST segment elevation with ST segment depression in aVR. The most appropriate next step in management is to
    A. administer nonsteroidal antiinflammatory agents
    B. obtain an echocardiogram
    C. obtain serial cardiac enzymes
    D. order serologies for coxsackie B virus
    E. treat the patient with a second-generation cephalosporin

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