No Pain

Cardiovascular System

{"ops":[{"insert":"Diagnosis and reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"Dyspnea of sudden onset may be due to a pneumothorax, pulmonary embolism (PE) or acute coronary syndrome (ACS).\n\nThe history of poorly controlled diabetes and hypertension (both of which are risk factors for ischemic heart disease), favor an ACS. Note that diabetic patients may not experience chest discomfort and autonomic overactivity in an ACS, because of phrenic neuropathy and autonomic neuropathy.\n\nThe unremarkable examination rules out a pneumothorax. PE remains a possibility.\n\nHis ECG shows a lateral ST segment elevation acute myocardial infarction (STEMI), establishing the diagnosis.\n\nAs STEMI may be secondary to an aortic dissection, portable chest radiography to exclude this possibility is important. In addition, echocardiography i"}]}

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