Reference no: EM132469804

JB is a 58-year-old male who presents to the emergency department with chest discomfort. The patient reports that he was out mowing his grass this morning when he noticed that he was more short of breath than usual. As he was finishing, he developed an ache in the center of his chest. Over the past 2 hours it has gotten worse and feels like someone has hit him in the chest. The pain is going up into his neck. He has never had pain like this before. Past Medical History: He reports that he has been healthy and does not follow with a doctor on a regular basis. He had shoulder surgery about 5 years ago for a torn rotator cuff, but has not had any other problems.

Medications: None

Family History: Parents are both alive. His brother had a heart attack when he was 52 years old.

Social History: Patient works in an office. He smokes 1/2 pack of cigarettes a day for 25 years. Occasional alcohol use.

Physical Examination: 58-year-old white male lying in bed. Appears uncomfortable.

Vital signs: Heart rate is 100 and regular, Resp: 18, BP: 128/76

HEENT: Sclera are non-icteric. PERRLA. Oropharynx is clear.

Neck: Normal thyroid size and without nodules. No evidence of elevated jugular venous pressure (JVD). Carotid upstrokes are normal, and there are no bruits.

Lungs: Clear to auscultation bilaterally.

Heart: Regular. PMI appears to be in the 5th left intercostal space. There are no murmurs, but an S4 is noted.

Abdomen: Soft. Non-tender. No palpable masses are found. Bowel sounds are present.

Extremities: No clubbing, cyanosis, or edema is noted.

Vascular: Radial, femoral, popliteal, dorsalis pedis, and posterior tibial pulses are equal bilaterally.

1. Based on the H&P, (and what we see in PINS/ICU) what common cardiovascular event is JB experiencing? What are the patient's cardiovascular risk factors?

Risk factors: White male, smoke, alcohol, work in office( sedentary life), family history (Brother has heart attack at age 52)