3rd August 2020

A tall 35-year-old man presents to A&E with a sharp, stabbing chest pain starting this morning

A tall 35-year-old man presents to A&E with a sharp, stabbing chest pain starting this morning. The history reveals that this is his first episode, beginning suddenly, with no known precipitants. He recalls that his father experienced a cardiac event as a young man. 

On general examination he is pale and sweaty, and his chest looks like the photo below.

Figure 1: https://upload.wikimedia.org/wikipedia/commons/8/83/Pectus1.jpg

Auscultation of the chest reveals a rumbling mid-diastolic murmur, heard loudest in the apex. Breath sounds are normal, with no added sounds. 

His observations are: HR: 125 bpm ; RR: 20/min; Temp: 36.8 degrees Celsius; BP: 80/50 mmHg; Oxygen saturation: 89% on air.

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