Interactive case report: A 42 year old man with acute chest pain

doi:10.1136/bmj.326.7395.920

BMJ 2003;326:920 ( 26 April )

Clinical review

Interactive case report

A 42 year old man with acute chest pain

G Sodeck, registrar ^a, B Partik, consultant ^b, H Domanovits, consultant ^a.

^a Department of Emergency Medicine, Vienna General Hospital, Währinger Gürtel 18-20, A-1093 Vienna, Austria, ^b Department of Radiology, Vienna General Hospital

Correspondence to: H Domanovits hans.domanovits@akh-wien.ac.at
The first 150 words of the full text of this article appear below.

Peter Hartl is a 42 year old man who enjoys working as an information technology specialist. He recently presented to hislocal emergency department with retrosternal chest pain. Two nightsearlier, he had experienced similar symptoms associated with epigastricpain. On the advice of his wife, a nurse, he started self treatmentwith a proton pump inhibitor and sucralfate. The remedies hadlittle effect, and during the next two days he experienced recurrentattacks of pain of a variable nature, which he thought were probablymusculoskeletal in origin. The pains did not respond to tizanidine,a muscle relaxant that is often prescribed for muscular pain.Because he had increasingly severe chest pain radiating to theback, his wife finally called a taxi and accompanied him to theemergency department. She was concerned that he might have anacute myocardial infarction.

Table Removed (Available Only in the Full Text)

On examination he was sweating profusely, his temperature was 36.8°C, his . . . [Full text of this article]

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

StumbleUpon Add to Technorati

Technorati What's this?

Relevant Article

A 42 year old man with acute chest pain: case outcome: G Sodeck, B Partik, and H Domanovits
BMJ 2003 326: 1133. [Extract] [Full Text] [PDF]

Rapid Responses:

Read all Rapid Responses

Response: raul e. garcia jimenez
bmj.com, 25 Apr 2003 [Full text]
Acute Coronary Syndrome: HAKIM ABID HUSSAIN, et al.
bmj.com, 25 Apr 2003 [Full text]
Acute Coronary Syndrome: Sudipta Maitra
bmj.com, 25 Apr 2003 [Full text]
A 42 year old man with acute chest pain possibly due to Prinzmetal�s angina: Christos Zavos
bmj.com, 25 Apr 2003 [Full text]
Chest pain,differential diagnosis: marc j mattys
bmj.com, 25 Apr 2003 [Full text]
Unstable Angina: Sanjay Suman
bmj.com, 25 Apr 2003 [Full text]
Let's be honest: we don't know: Steve Goodacre
bmj.com, 25 Apr 2003 [Full text]
A 42 years old with chest pain: Adullah M. A Shehab
bmj.com, 26 Apr 2003 [Full text]
Interactive case response:: Malvinder S Parmar
bmj.com, 26 Apr 2003 [Full text]
No definitive diagnosis yet but needs urgent management: Mohammed S Abouzeid, et al.
bmj.com, 26 Apr 2003 [Full text]
A 42 year old man with acute chest pain ( unstable angina): Lubna A Al-Ansary
bmj.com, 26 Apr 2003 [Full text]
Insufficient data to jump to conclusions: Anthony N Glaser
bmj.com, 26 Apr 2003 [Full text]
What type of hospital am I at?: Andrew G. Robinson
bmj.com, 26 Apr 2003 [Full text]
Following are answers: himmatrao Saluba Bawaskar
bmj.com, 26 Apr 2003 [Full text]
Acute Coronary Syndrome: JYOTI RAMNIK PAREKH
bmj.com, 26 Apr 2003 [Full text]
It can be disscecting aneurysm of the Aorta: Karthik M
bmj.com, 26 Apr 2003 [Full text]
Aortic dissection in a hypertensive patient: Joanna N Tenkorang
bmj.com, 26 Apr 2003 [Full text]
aortic dissection until proven otherwise: M D Dominic Bell
bmj.com, 26 Apr 2003 [Full text]
CLOSE FOLLOW UP WILL HELP: ANJANELU.S CHITTA
bmj.com, 26 Apr 2003 [Full text]
Treat as cardiac untill proven otherwise.: Chris topher L. Larmour
bmj.com, 26 Apr 2003 [Full text]
Acute Chest Pain: Padmakumar N Pillai
bmj.com, 26 Apr 2003 [Full text]
Aortic dissection: Bernardino Roca
bmj.com, 26 Apr 2003 [Full text]
?mi,?acute pancreatitis,?pulmonary embolism: krishna kumar jada
bmj.com, 26 Apr 2003 [Full text]
acute coronary syndrome: Dr. S. Ranjan
bmj.com, 26 Apr 2003 [Full text]
Treat as a precordialgia (angina): Vitor S Hipolito
bmj.com, 26 Apr 2003 [Full text]
Suspect Disecting Aortic Aneurism: Mark R Hambly
bmj.com, 26 Apr 2003 [Full text]
gastroesophageal reflux disease: malik rehman abdul
bmj.com, 26 Apr 2003 [Full text]
acute miocaidium infarct: rosio guerra
bmj.com, 26 Apr 2003 [Full text]
treat as a case of dissecting aortic aneurysum: DR.ZAKI HUSSAIN KHAN
bmj.com, 26 Apr 2003 [Full text]
exlude worst: Dragan Trivanovic
bmj.com, 27 Apr 2003 [Full text]
is this aortic dissection: ravindhar vodela, et al.
bmj.com, 27 Apr 2003 [Full text]
chest pain: nico de paola
bmj.com, 27 Apr 2003 [Full text]
Treat as Acute Coronary Syndome until proven otherwise: Sanjay P Ramdany
bmj.com, 27 Apr 2003 [Full text]
Response: William Parsonage
bmj.com, 27 Apr 2003 [Full text]
Acute coronary syndrome: Alejandro S Kufert
bmj.com, 27 Apr 2003 [Full text]
Aortic dissection: seyed amin zamiri
bmj.com, 27 Apr 2003 [Full text]
Urgency MI: Miguel FE Derijcke
bmj.com, 27 Apr 2003 [Full text]
Aortic dissection definitely can't be excluded: Shuk Yi Annie Hui
bmj.com, 28 Apr 2003 [Full text]
Dissecting Aortic Aneurysm must be Excluded: Nathan P. Gottehrer
bmj.com, 28 Apr 2003 [Full text]
Minor opinion: Regina B Stroebele
bmj.com, 28 Apr 2003 [Full text]
Myocardial Sarcoidosis: Michael D Innis
bmj.com, 28 Apr 2003 [Full text]
Radiologist in the byline...: Andrew G. Robinson
bmj.com, 28 Apr 2003 [Full text]
Aortic dissection: shujauddin khokhar
bmj.com, 28 Apr 2003 [Full text]
TYPICAL OF CARDIAC ARRHYTHMIAS: kumar R S bhamidimarri
bmj.com, 28 Apr 2003 [Full text]
patient with AMI: ariefiansyah -, et al.
bmj.com, 28 Apr 2003 [Full text]
Could it be pancreatitis?: Hsu Phern Chong
bmj.com, 29 Apr 2003 [Full text]
the troubling case: hernan combessies
bmj.com, 29 Apr 2003 [Full text]
Managing Chest Pain: Sheikh M Haq
bmj.com, 29 Apr 2003 [Full text]
Cardiac unless proven otherwise but HOW??: S BAJWA
bmj.com, 29 Apr 2003 [Full text]
Agatha Christie?: Alistair Howitt
bmj.com, 29 Apr 2003 [Full text]
Abdominal causes should be considered too.: Deepak Kejariwal
bmj.com, 29 Apr 2003 [Full text]
Patient permitted his details to be published: Marcus M�llner
bmj.com, 29 Apr 2003 [Full text]
Aortic Dissection: GAMAL ALFITORI, et al.
bmj.com, 29 Apr 2003 [Full text]
chest pain - ANXIETY/POLTIMI?: yahaya yusuf aniki
bmj.com, 30 Apr 2003 [Full text]
thoracic dissection: fergus joseph dignan
bmj.com, 30 Apr 2003 [Full text]
WPW vs AORTIC DISSECTION: KUMAR RS BHAMIDIMARRI
bmj.com, 30 Apr 2003 [Full text]
AS USUAL NOT SURE ABOUT THE DIAGNOSIS: VATSALA S VARADHARAJAN
bmj.com, 30 Apr 2003 [Full text]
acute aortic dissection: manfredo turcios, et al.
bmj.com, 30 Apr 2003 [Full text]
angina: sadaf salahuddin
bmj.com, 30 Apr 2003 [Full text]
Acute Coronary syndrome: Adel H Regaila
bmj.com, 30 Apr 2003 [Full text]
It should be acute coronary syndrome: Dr.M.Thirughnanam Muthukumarasamy
bmj.com, 30 Apr 2003 [Full text]
Aortic dissecting aneurysm: Mauricio Mejia, et al.
bmj.com, 30 Apr 2003 [Full text]
?PERICARDITIS: JM Rumbold
bmj.com, 30 Apr 2003 [Full text]
NON: ZAMAN AMJAD, et al.
bmj.com, 30 Apr 2003 [Full text]
Unstable angina: Dr.Juan Landaburu
bmj.com, 1 May 2003 [Full text]
chest pain: francis William Doyle
bmj.com, 1 May 2003 [Full text]
A 42 year old man with acute chest pain: Marin Marinovic
bmj.com, 1 May 2003 [Full text]
peter hartl's condition: Amin O Sharieff
bmj.com, 1 May 2003 [Full text]
Rule out pancreatitis and aortic dissection: Carolina Acu�a
bmj.com, 1 May 2003 [Full text]
Acute chest pain: Jose E. Roel
bmj.com, 1 May 2003 [Full text]
GP commentator's response: Alistair J Howitt
bmj.com, 1 May 2003 [Full text]
R/O ACS then think about DES: hoda kavosi
bmj.com, 2 May 2003 [Full text]
42 yr old with unstable angina: Alexander F Browne
bmj.com, 2 May 2003 [Full text]
Acute Coronary Syndrome?!!: Shabbar Bukhari
bmj.com, 2 May 2003 [Full text]
Emergency consultants response: Harald Herkner
bmj.com, 3 May 2003 [Full text]
the one diagnosis that should not be missed: Samer A M Nashef
bmj.com, 3 May 2003 [Full text]
acue chest pain: shyama rathore
bmj.com, 3 May 2003 [Full text]
Chest Pain: Akanu abass Obasi
bmj.com, 4 May 2003 [Full text]
Aortic dissection in a hypertensive man: Mohamad Abdelsalam Abdelkader
bmj.com, 9 May 2003 [Full text]
response from rizgary hospital: mothafar abdulrahman habib
bmj.com, 9 May 2003 [Full text]
Pancreatitis?: Letterio Rizzo
bmj.com, 11 May 2003 [Full text]
Obscure diagnosis w/symptoms presenting as chest pain: Richard C Berglund, MD
bmj.com, 11 May 2003 [Full text]
not seem to be acute: alparslan sahin
bmj.com, 15 May 2003 [Full text]
Acute coronary syndrome: Heong Keong Goh
bmj.com, 15 May 2003 [Full text]
Chest pain 42 year old man: Stephanie Mullings
bmj.com, 15 May 2003 [Full text]
Retrosternal pain-normal ECG: Boudewijn J G G De Wilde
bmj.com, 19 May 2003 [Full text]
EXCLUSION: ashwaq alhadithi
bmj.com, 21 May 2003 [Full text]
Dissection of the thoracal aorta: Oliver Lammel
bmj.com, 23 May 2003 [Full text]
acute aortic dissecying aneurysm: anil maurya
bmj.com, 27 May 2003 [Full text]
Re: Patient permitted his details to be published: Hugh de Glanville
bmj.com, 3 Jun 2003 [Full text]
Re: Re: Patient permitted his details to be published: Beth Bennett
bmj.com, 27 Jun 2003 [Full text]
Response: Suzete V. Mayo
bmj.com, 24 Nov 2003 [Full text]
IT IS DIFFICULT TO SAY AS NO SINGLE DIAGNOSTIC TEST TO CONCLUDE DIAGNOSIS: Mohammed Azizuzzaman
bmj.com, 20 May 2004 [Full text]
my opinion: Laurentiu Iamandi
bmj.com, 28 Feb 2007 [Full text]