Chest Pain with a Surprising Course

Abstract

This Clinical Problem-Solving case is based on a presentation at the Beth Israel Deaconess Medical Center Morbidity and Mortality Conference. A 73-year-old man with insulin-dependent diabetes mellitus and a history of coronary artery disease came to the emergency department because of chest pain of one hour's duration that radiated to the jaw and back, shortness of breath, diaphoresis, and a nonproductive cough. The pain was similar to the angina he usually experienced, except for an intermittent pleuritic component with accompanying discomfort on the right side of the chest. An electrocardiogram showed right bundle-branch block with T-wave inversion in leads . . .