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Chest Pain, Dyspnea, and Cor Pulmonale

Melvin E. Clouse, MD
JAMA. 1965;191(7):550-552. doi:10.1001/jama.1965.03080070034009.
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Dr. Melvin E. Clouse: A 39-year-old man noted the onset of easy fatigability, dyspnea on exertion, but no orthopnea four months ago. Two months before admission he developed an upper respiratory infection with chills and fever lasting 48 hours. After this he was asymptomatic except for dyspnea on exertion until two weeks later when he experienced the acute onset of left pleuritic pain on the left side of the chest, made worse by motion and change of position; it radiated throughout the anterior portion of the chest and left shoulder. There were no chills, fever, sweats, syncope, or cyanosis. He was hospitalized with chest pain, but did not appear acutely ill. Blood pressure was 120/70 mm Hg with a paradoxical pulse of 10 mm Hg. Temperature was 98.6 F (37 C) and respirations 24 per minute. Pertinent physical findings included decreased excursion of the left hemidiaphragm without evidence of rubs


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