# 70-year-old Woman with Chest Tightness and Shortness of Breath

## TL;DR

A 70-year-old woman's chest tightness and shortness of breath led to an unexpected diagnosis after a detailed evaluation in the emergency department.

## Contribution

The case highlights the importance of a thorough patient history in guiding accurate diagnosis and management in the ED.

## Key findings

- A detailed history and examination can significantly alter the differential diagnosis in ED patients with chest symptoms.
- The final diagnosis was unexpected and emphasized the value of integrating clinical findings for proper management.

## Abstract

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.