An 18-Year-Old Female with Sudden Sharp Chest Pain

Figure 1.

Case

The patient is an 18-year-old female who presents to urgent care with 1–2 hours of “sharp” chest pain that worsens with range of motion. She reports it began suddenly while lifting boxes at work. Pain is not improved with acetaminophen. She denies exertional discomfort, pleuritic pain, and use of hormone therapy. There is no leg swelling, shortness of breath, or sweating.

Physical exam reveals:

• General: Sitting comfortably on the cart, breathing normally
• Lungs: Clear bilaterally
• Cardiovascular: Regular rhythm, without m,r,g
• Chest: There is point tenderness over the left lower sternal border
• Abdomen: Soft and NT, no distention, without r/r/g
• Ext: No edema or asymmetry, pulses are 2+ and equal in all extremities, no pain with palpation

View the ECG and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.