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Sent by anonymous, written by Pendell Meyers, reviewed by Smith and Grauer A man in his 40s presented to the ED with HTN, DM, and smoking history for evaluation of acute chestpain. He was eating lunch when he had sudden onset chest pressure, 9/10, radiating to his back, with sweating and numbness in both hands. was discovered.
No patient with chestpain should be sent home without troponin testing. An echocardiogram showed severely reduced global systolic function with an EF of 20-25% and an LV apical thrombus. An echocardiogram showed an EF of 20-25%. Three months later, he had a follow up appointment for a reassessment of his LV function.
Hopefully a repeat echocardiogram will be performed outpatient. ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of ChestPain and Dyspnea Head On Motor Vehicle Collision. 1900: RBBB and LAFB are almost fully resolved.
His medical history is unremarkable except a similar pain occurred 4-5 times in the previous 3 months with less intensity, short duration, unrelated to exertion. He visited an outpatient clinic for it and an echocardiogram and exercise stress test was normal. He has 40 packs-year of smoking history.
He was concerned because he had chestpain after his first mRNA vaccine and was uncomfortable with the risks of a second mRNA dose. It is relevant to note here that as a physician active clinically in both the inpatient and outpatient arenas, I am an eyewitness to the severe toll COVID19 took on my patients in the Spring or 2020.
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