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The pain is substernal with radiation to left shoulder and back.
Cue for myocardial disease.
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Exertion was not a precipitating cause. Cue against myocardial
disease.
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Patient’s pain was relieved by rest and only slightly by
nitroglycerin. Evidence inconclusive or contradictory. Morphine should
have decreased pain substantially.
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The initial ECG and cardiac enzymes do not support myocardial
ischemia. Clues against myocardial disease.