ECG Case: 22-year-old Man with Anterior Chest Pain

by Joseph Alpert, MD

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    00:01 Well, we've covered a lot of important definition material and you may need to repeat this lecture a couple of times to make sure you have all of the numbers down or you may have taken notes on that so you remember.

    00:13 Once you start reading ECGs, it'll become easy to remember what the various intervals should be.

    00:19 Oh, the PR needs to be less than 5 little boxes, and so forth. Let's do a case.

    00:24 Okay. Here's a 22-year-old male student who's the captain of the university boxing team and he comes in to you because he's having anterior, that is chest -- pain in the front of his chest.

    00:35 The discomfort occurs several times each day and lasts for 1 to 2 hours.

    00:40 On physical exam, he's very tender when you touch the sternum and he did admit that during a number of boxing matches recently, he took a number of hits on the sternum.

    00:50 By the way, what are the important points here? Number one, chest pain.

    00:54 That's why he was referred. Number two, there's a history of some thoracic trauma and here is the ECG.

    01:00 So, it's a normal ECG. It's the one I showed you before.

    01:05 So that's very reassuring because what we were worried about - well, we worried that maybe you know, he'd gotten some injury to the blood vessels in the heart and maybe he had a heart attack during one of these episodes.

    01:18 So, the patient's chest pain is musculoskeletal in origin.

    01:22 It's the result of the trauma that he suffered when he was boxing and you can reassure the patient it'll get better with time.

    01:29 Treatment: you can give some non-steroidal, anti-inflammatory agent such as Naprosyn and reassurance and no further testing is required.

    About the Lecture

    The lecture ECG Case: 22-year-old Man with Anterior Chest Pain by Joseph Alpert, MD is from the course Electrocardiogram (ECG) Interpretation.

    Included Quiz Questions

    1. There is still a suspicion of myocardial infarction.
    2. The patient's chest pain is musculoskeletal in origin.
    3. Treatment for this patient would include nonsteroidal anti-inflammatory drugs.
    4. Thoracic trauma can lead to myocardial infarction.
    5. The patient’s condition is likely to improve with time.

    Author of lecture ECG Case: 22-year-old Man with Anterior Chest Pain

     Joseph Alpert, MD

    Joseph Alpert, MD

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