67-year-old man with a known history of heart disease, two heart stents, and a known history of thoracic spinal stenosis pending back surgery developed an acute and sharp back, chest, shoulder, left chin, left neck and left arm pain that woke him early in the morning. The pain was so severe that he called 911 and activated EMS.
According to the patient, the pain subsided greatly by the time EMS arrived. He was given an EKG which did not show evidence for acute heart attack. He was told not to take his angina medication if he had no chest pain. He was sent for follow-up for his upper back pain.
A STAT blood work done at office showed elevated troponin level indicating an acute heart attack.
77-year-old lady acute onset left forearm and hand pain with tingling for 3 hours - she was walking around and trying to shake off this pain when her doctor's nurse called to check on her knee pain after a knee injection the day before. She told the nurse the knee pain was gone (she could walk now) but she was bothered by the new left arm and hand pain.
The nurse immediately informed the doctor. The doctor, recognizing the unusual combination of acute pain with tingling sensation in an extremity, called back and informed her to go to the ER or call 911.
At the ER gate, the patient's left forearm and hand suddenly turned blue and the pain became unbearable.
She was rushed to interventional radiology. An arteriogram showed a wedge-shaped blood clot at the elbow level. This was removed. Her pain resolved.