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A Man Had Intermittent Chest Pain (General physical examination (Vital…
A Man Had Intermittent Chest Pain
Symptoms
intermittent retrosternal chest pain for 2 days
sharp pain/pain score 2
referred pain: radiating to back
aggravating/relieving factors:
worse in supine/better in sitting
associated symptoms: fever occurred one day later
no dyspnea or respiratory tract symptoms
no trauma history
no sysmetic disease
no smoking/no medicine/no illicit drug use/
no family history of myocardial infarction
General physical examination
Vital sign: BP:144/86 mmHg / SpO₂ 96% in ambient air
T/P/R: 38.2℃/ 119bpm/18per min
HEENT: anicteric sclera, pink conjunctiva, isocoric pupil with light reflex, nasal discharge(-), ear discharge(-), oral ulcers(-)
BW: 65.6kg / BH:157.7cm / BMI: 26.6kg/m²
Chest: symmetric expansion, breath sound: clear, no audible crackles
Consciousness: clear and oriented
Heart: regular heart beats, a Gr. III/VI diastolic murmur, max at left lower sternal border / no friction rub
Abdomen: soft and flat, no operation scar
Bowel sound: normal active, no tenderness, no hepatomegaly
Liver/spleen: impalpable
Back: no back pain or costovertebral angle knocking tenderness
Extremity: warm, free movable, pitting edema(-), cyanosis(-), symmetric periphery pulsation
Skin: rash(-), abnormal pigmentation(-), petechiae(-), purpura(-), ecchymoses(-), tenlagiectasia(-), plaque(-)
Examination
Possible disease
Stable/unstable angina pectoris🚫CK-MB不變
Aortic dissection:有放射痛，有Gr. III/VI diastolic murmur，無摩擦音，前驅症狀易誤診為心包膜炎；pain score通常9~10
Myocardial infarction:有放射痛，一天後發燒🚫CK-MB↑
Pericarditis:前傾時胸痛改善，後躺加劇；伴隨高燒
🚫通常會有摩擦音；X光下是water bottle shape
Endocarditis:🚫常伴隨全身性症狀如發燒、肝脾腫大
HHV(Shingles)
Gastroesophageal reflux disease:前傾時胸痛改善，後躺加劇
Lung cancer
Thyroid tumor
Pneumonia
Need to know
ST elevation
Pericarditis
EKG introduction
Myocardial infarction
Chest X-ray
Aortic dissection
Auscaltation
