A 46 year old male with a past medical history of hypertension presents to the emergency room complaining of constant throbbing epigastric pain for one day. He rates the pain as 7/10, with some radiation to his chest. He reports some mild nausea, but denies diarrhea or constipation. He does endorse a bloated sensation for the past few days. He has not had any fevers and denies melana or hematochezia. He is an avid biker and reports unlimited exercise tolerance. He denies any previous history of chest pain.
The patient works as a landscaper. He does not smoke and drinks socially on the weekends. His only medication is hydrochlorothiazide 25 mg daily. He has never had any surgeries. His father died of lung cancer at age 72, his mother is alive and well.
Pt appears mildly anxious but is otherwise in no distress. He is afebrile, BP 150/90, pulse 98, respiration rate 16. Physical exam is remarkable only for some mild epigastric tenderness without rebound tenderness or guarding.
ECG is sinus rhythm, no st or t changes.
WBC is 16 (82% neutrophils), h/h 14/42, plt 247
Basic metabolic panel is within normal limits. Liver function tests, amylase, lipase are also all within normal limits.
Initial cardiac enzymes are negative.
The patient is admitted to the medicine service by the emergency room as a “r/o MI.”
A CT A/P with po and IV contrast is ordered by the medical team: