Clinical Practice and Cases in Emergency Medicine

Chest tightness and shortness of breath are relatively common reasons for presentation to the emergency department (ED), often triggering protocolized workups and dispositions. A good history, however, can reveal additional elements that may dramatically alter the differential diagnosis and management. A 70-year-old woman presented to the ED complaining of subacute chest tightness with dyspnea on exertion. This case offers a thoughtful analysis of how to integrate key findings within a patient’s history, exam, and workup in the ED. The surprising final diagnosis and case outcome are then revealed.