Welcome back to case two of the chest pain week with the Human Diagnosis Project.

We also like to welcome back our special guest, Hannah Abrams.

I had to include Dr. Vivek Murthy's guitar instrumental because it just connects with my soul.

I hope you enjoy this episode.

Make sure to try to solve the case before listening to it.

Thank you. make sure to try to solve the case before listening to it. So our next case is by Dr. Chad Aldenoff, who's a cardiology fellow at the University of Utah.

It's the case of a 40-year-old man who presents to the ER with acute onset chest

pain and shortness of breath. So this is the case of a 40-year-old man who is presenting

with acute onset chest pain. His chest pain is severe, sharp, and sub-sternal. He says it's radiating

to the upper back and the bilateral jaws for the past two hours. Nothing's improving it,

nothing's making it worse, but he does have some nausea, lightheadedness, and diapheresis,

and he says he's never experienced anything like this before. He's also been feeling short of

breath for the past hour, so about one hour after his chest pain started. And he feels

that shortness of breath at rest, and it's worse with exertion. You do a quick physical exam. His

vital signs, his heart rate is 130, his blood pressure is 80 over 60 in the right brachial, and 110

over 70 in the left brachial. He's in pain and restless, with warm

extremities, and you notice that he has a slim and tall body habitus. On cardiopulmonary exam,

he's tachycardic with regular rhythm, a soft early diastolic murmur, normal S1 and S2,

and rails in both lung faces.

Okay. So we have a 40-year-old gentleman who's presenting with acute onset chest pain and

shortness of breath. When I get a call to come to the emergency department to evaluate chest pain,

I always consider three diagnoses, acute coronary syndrome,

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