HPI:
A 17-yo male presents to the ED complaining of palpitations, most notably when lying on his left side. He states that his heart is “beating out of my chest” but not beating rapidly. He noted left-sided chest pain while running the night prior to presentation. He describes the chest pain as sharp, and lasting approximately 3 hours. He denies syncope or presyncope, recent trauma.
PMHx: Burn to his chest with skin grafting at age 4.
SocHx: he smoked for 1 year, but quit 1 month ago. He drinks multiple caffeinated beverages throughout the day. He is enrolled in school and drives a car.
Meds: none, and denies OTC meds or herbals or supplements.
ROS: no shortness of breath or cough; no N/V/D; no dizziness; no fever. Rest of review of systems other systems were negative.
Exam:
Vital Signs: BP 125/67, HR 69, RR 16, Temp 97.5
Gen: Awake and alert, non-toxic, no distress.
Neck: supple, no JVD, no bruits
Lungs: clear bilaterally posteriorly.
Cardiac: regular rate and rhythm. He had a click and a palpable thrill when in the left lateral decubitus position. His pain returned when he turned onto his left side.
Abdomen: soft and non-tender.
Ext: without cyanosis, clubbing or edema.
CXR:
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