This month’s case is about a 61-year-old man who presents to an Emergency Department. The listed chief complaint is chest pain, but the following notes from nurses and the physician indicate that the presentation was more complicated.
The triage nurse documented the chief complaint as chest pain, but later documented that the patient “denies chest pain”. A snippet of the nurse documentation is shown here.
The physician saw the patient and documented the following HPI.
The review of systems did not reveal any additional information.
He did not have a long medication list. He only took warfarin, metoprolol and a multivitamin.
From the patient’s past medical history, we can deduce that the patient’s anticoagulation was started due to his history of aortic valve replacement. The surgical history also contains a comment that he had a mitral valve replacement as well.
The patient’s vitals were initially normal, and over the next few hours did not show any significant changes.
The physician’s examination is shown below.
With this information, what tests would you order?
Continue to the next page to see the testing and results!
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