Case 5: Chest Pain and Elevated Troponin in a Teenager

1. Benson S. Hsu, MD, MBA* 2. Mary Guillot, MD* 3. Jennifer Mosher, MD† 4. Theresa Stamato, MD* 1. *Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD 2. †Department of Pediatrics, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND A 16-year-old boy presents to a local emergency department with the acute onset of chest pain. He describes the pain as sharp, stabbing, and directly over his sternum with radiation to his back. Before this presentation, he had 1 week of upper respiratory and gastrointestinal symptoms, including cough, rhinorrhea, and diarrhea. Physical examination reveals a nontoxic-appearing teenager with a temperature of 98.06°F (36.7 ° C), heart rate of 93 beats/min, respiratory rate of 23 breaths/min, blood pressure of 116/65 mm Hg, and oxygen saturation of 96% in room air. His height is 66 in and weight is 66.4 kg for a body mass index of 23.5. His cardiac examination documents regular rate and rhythm and no murmurs, rubs, or gallops. His respiratory examination reveals good air entry throughout without wheezing or crackles. Capillary refill is at 2 seconds, and he has warm and well-perfused extremities. Abdominal examination findings are benign and sternal pain is noted at the xiphoid process. In the emergency department, his chest pain improves with treatment directed at gastroesophageal reflux. …