Chest Pain in 74-Yr-Old Man

Physical Examination

  • General appearance: Well-developed elderly African-American man in minor distress.

  • Vital signs:
  • Temperature: 36.3° C
  • Pulse: 110 beats/min
  • Right Arm: 142/84 mm Hg
  • Left Arm: 142/80 mm Hg
  • Respirations: 20/min
  • Oxygen saturation: 96% on room air

  • Skin: Slight pallor. No cyanosis. Cool, dry to the touch.

  • HEENT: Clear oropharynx. No cervical lymphadenopathy. Normal carotid upstrokes.

  • Pulmonary: Normal effort. Decreased breath sounds bilaterally with prolonged expiratory phase. No crackles or wheezes noted.

  • Cardiovascular: No jugular venous distention at 45°. Regular rhythm and rate. Point of maximal impulse (PMI) not displaced. S1 decreased, S2 normal. Grade 1-to-2, soft, early systolic murmur heard at the apex. S4 present. No rubs or gallops. No peripheral edema.

  • Gastrointestinal: Normal bowel sounds. No epigastric tenderness.

  • Genitourinary: No costovertebral angle tenderness.

  • Musculoskeletal: Unremarkable; no erythema, tenderness, or swelling in the legs.

  • Neurologic: Alert and oriented x 3. No focal motor or sensory deficits.

  • Mental status: Appropriate mood and behavior.