URI and Chest Pain in a 31-Year-Old Man

May 20, 2015

The patient has had respiratory infections before but he has never experienced chest pain like this in the past. How would you work up this case?

A 31-year-old man presents to the emergency department with sore throat, body aches, dry cough, chest pain, and fever of several days’ duration. He is otherwise healthy and denies use of tobacco or illicit drugs. The chest pain is significantly worse than the body aches and concerns him most. He states he never has had this kind of pain associated with respiratory infections in the past. The patient describes the pain as a constant “ache” in the middle of his chest that is neither pleuritic nor exertional, but is persistent and not worsened by, or apparently related to, coughing.

On physical examination, his vital signs are normal except for a temperature of 38.4°C (101.2°F) and a pulse of 108 beats/min. His head and neck exam is normal except for rhinorrhea. There is no apparent pharyngitis or lymphadenopathy. His lungs have no rales but some mild expiratory wheezing is noted. Heart sounds are normal except for the elevated rate. His abdomen is benign. Extremities have symmetric pulses with no edema, tenderness, or chords. The patient is given acetaminophen and oral fluids, and his vital signs normalize. An influenza swab is sent for testing and results are negative. A chest x-ray film is read by the radiologist as normal. An ECG is also obtained. The precordial leads are shown in the Figure above (click on image to enlarge).

Is this ECG normal or abnormal?

What is the most likely diagnosis?

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