CHIEF COMPLAINT: The patient complains of chest pain. HISTORY OF PRESENT ILLNESS: The patient is a 20-year-old male who

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CHIEF COMPLAINT: The patient complains ofchest pain.HISTORY OF PRESENT ILLNESS: The patient is a20-year-old male who states that he has had two previous myocardialinfarctions related to his use of amphetamines. The patient has notused amphetamines for at least four to five months, according tothe patient; however, he had onset of chest pain thisevening. The patient describes the pain as midsternal pain, aburning type sensation that lasted several seconds. The patienttook one of his own nitroglycerin tablets without any relief. Thepatient became concerned and came into the emergencydepartment.Here in the emergency department, the patient states that his painis a 1 on a scale of 1 to 10. He feels much more comfortable., REVIEW OF SYSTEMS: He denies anyshortness of breath but does complain of abdominal pain. States that the pain feels unlike the pain of his myocardialinfarction. The patient has no other complaints at this time.
PAST MEDICAL HISTORY: The patient's pastmedical history is significant for status post myocardialinfarction in February of 2015 and again in late February of 2015.Both were related to illegal use of amphetamines.
SOCIAL HISTORY: Patient has usedamphetamines in the past.
ALLERGIES: None.
CURRENT MEDICATIONS: Include nitroglycerinp.r.n.PHYSICAL EXAMINATION:VITAL SIGNS: Blood pressure 131/76, pulse 50, respirations 18,temperature 96.5.GENERAL: The patient is a well-developed, well-nourished white malein no acute distress. The patient is alert and oriented x 3 andlying comfortably on the bed.HEENT: Atraumatic, normocephalic. The pupils are equal, round, andreactive. Extraocular movements are intact.NECK: Supple with full range of motion. No rigidity ormeningismus.CHEST: Nontender.LUNGS: Clear to auscultation.HEART: Regular rate and rhythm. No murmur, S3, or S4.GASTROINTESTINAL: Abdomen soft, nondistended, nontender with activebowel sounds. No masses or organomegaly. No costovertebral angletenderness.EXTREMITIES: Unremarkable.NEUROLOGIC: Unremarkable.
EMERGENCY DEPARTMENT LABS: The patient hada CBC, minor chemistry, and cardiac enzymes, all within normallimits. Chest x-ray, as read by me, was normal. Electrocardiogram,as read by me, showed normal sinus rhythm with no acute ST orT-wave segment changes. There were no acute changes seen on theelectrocardiogram. O2 saturation, as interpreted by me, is99%.EMERGENCY DEPARTMENT COURSE: The patient hada stable, uncomplicated emergency department course. The patientreceived 45 cc of Mylanta and 10 cc of viscous lidocaine withcomplete relief of his chest pain. The patient had no furthercomplaints and stated that he felt much better shortlythereafter.AFTERCARE AND DISPOSITION: The patient wasdischarged from the emergency department in stable, ambulatory,good condition with instructions to use Mylanta for his abdominalpain and to follow up with his regular doctor in the next one totwo days. Otherwise, return to the emergency department as neededfor any problem. The patient was given a copy of his labs and hiselectrocardiogram. The patient was advised to decrease his level ofactivity until then. Patient to continue nitroglycerin as neededfor chest pain.FINAL DIAGNOSIS:1. Chest pain; possible esophageal reflux.
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