A 37-year-old male presented to the ED with two days of chest pain . constant, rated at a level of 3 (on a scale of 0 to 10), and slightly worsening on deep inspiration. He described increased shortness of breath with exertion and a cough productive of clear sputum but denied fevers, chills, nausea, lightheadedness or sweating. The patient was a pale, obese male who appeared in no acute discomfort .temp - 97.5◦F ,1 Rr18 beats/minute BP 102/72 mmHg RR 18 Spo2 -96% CVS s1s2+ Rs : Rales at the lung bases bilaterally P/a Soft, nontender, nondistended. CNS Nonfocal. TLC 18 K/μL with 90% neutrophils, hematocrit - 31% creatinine - 1.5 mg/dL positive D-dimer. troponin I - normal

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Low voltage ecg Per effusion or cong cardiomyopathy

Thanks Dr Lekh ram
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pleuritic type chest pain with dyspnoea and productive cough favours primary lung pathology.. That with sinus tachycardia, leucocytosis and positive d-dimer in an obese patient.. could be pulmonary embolism(non massive)... xray also shows rt sided chamber enlargement..However other possibilities too need to be considered.. echo followed by CTPA would be my advise.

Agree with Dr.shaiesh agrawal
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Low voltage ECG but tachycardia.Do an X-ray Chest PA view.There is neutrophilia so pleural effusion due to Pnemonia may be there. X-ray chest may differentiate cause of Cardiomegaly.An Echo may be suggested .

Ecg show Low voltage in chest leads Flat st t in multiple leads X-ray show Cardiomegaly Need clinical corelation

Pulmonary infraction with effusion leading to breathless ness and shortness of breath and cough

Cardiomegaly Ecg shows poor r wave progression with low voltage ecg

Pericarditis

Possibilities are: ?Pleuro-pericardial effusion ?Pleuritis Could be ?days old MI. Get 2d-echo done. ?Congestive Cardiac failure. Fluid Overload secondary to renal failure. (USG renals for renal sizes).

To rule out Acute Respiratory tract infection. Patient has e/o target organ damage like cardiomegaly, raised serum creatinine plus some dehydration and anemia. Any history of diabetes mellitus?

Ecg is pretty inconclusive and so are the symptoms. High probability of ild suggested by rales sometimes chest pains. Go for hrct lungs . Any secondaries?

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