Chest Pain and a Sore Throat.

DR. COURTENEY MACKUEN: The patient was a 36-yearold-man who presented to the Emergency Department (ED) with the sudden-onset of substernal chest pain that woke him from sleep just prior to arrival. The pain was sharp and radiated down his left arm. It was associated with shortness of breath and diaphoresis. He had never experienced similar pain previously. The patient was otherwise a healthy, employed, married man with two children at home. He reported subjective fevers and chills three days prior to his visit and had had several loose stools. He also complained of a sore throat and headache for the past several days. He denied cough or runny nose, and he denied abdominal pain. He stated that he had been taking ibuprofen for the past 24 hours because he was simply not feeling “well.” The patient denied any illicit drug use and is a former smoker. Ill contacts included his 9-year-old son who was diagnosed with streptococcal pharyngitis approximately two weeks prior to presentation and was treated with amoxicillin for ten days. His family history is only significant for coronary disease in his father at the age of 55. The patient has two dogs and keeps an aquarium.