Abstract
One afternoon, at the beginning of my first clinical clerkship in internal medicine, my team was called to the intensive care unit. A patient, whom I'll call Mr. Abbott, had just been admitted with excruciating chest pain that had started a few hours earlier. He was in his early 50s, extensively tattooed, just the sort of tough I wouldn't want to meet alone in a parking lot at night — but right then he was whimpering. He kept stroking his sternum up and down, as if trying to rub the pain away. It was obvious that he was having an acute coronary syndrome. He had all the classic risk factors: hypertension, high cholesterol level, a history of cigarette smoking. His electrocardiogram showed T-wave inversions characteristic of ischemia. His serum troponin level was elevated. I don't recall our examining him, but for this most common type of cardiac emergency, there is little diagnostic role for the physical exam.

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