Author: Amin Farokhrani, MD, MSE
Co Author #1: Dr. Kim Gladden
Co Author #2: Dr. Dermot Phelan
Editor: Benjamin Hasan, MD
Senior Editor: Kristine Karlson MD
A 59 year old male bicyclist presented to the local emergency department with unremitting peri-scapular pain, left side worse than right.
A 59-year-old life-long endurance athlete with no significant past medical history presented with mid back and shoulder pain while in Nevada cycling up an 8000 foot peak. His symptoms were associated with extreme fatigue, tightness in his upper back and shoulders without radiation and the sensation of an irregular pulse. He described a recent history of similar symptoms early in his activity which resolved once he slowed or stopped exercising. He could subsequently exercise at a high level of intensity without symptoms. On this occasion the pain did not resolve, and it actually worsened. He did continue his cycling for the day at a slower pace before eventually presenting to the emergency room.
The patient had a known family history of premature coronary artery disease (CAD).
He was clinically stable. His heart rate was bradycardic. Other vitals were stable. His BMI was 21.97.
General: He appeared well developed, well nourished, and in no acute distress.
Lungs: Chest exam was clear to auscultation bilaterally.
Heart: A normal point of maximum impulse was palpated. He had bradycardia, a regular rhythm, and no murmurs, rubs, or gallops.
Neurologic: He was alert and oriented x4 with no gross neurological deficits.
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