The Appropriate Degree of Diagnostic Certainty

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Abstract
A previously healthy 47-year-old man presented to the emergency room after the sudden onset of cough, shortness of breath, and tightness in his chest while climbing stairs.The first thing that occurs to me is that this man may be having acute myocardial ischemia. The chest tightness is especially suggestive of an ischemic episode. Shortness of breath and cough are not commonly major manifestations of an acute myocardial infarction, but they can be. Another diagnostic possibility is the sudden onset of a cardiac arrhythmia. Atrial fibrillation with a rapid ventricular rate or ventricular tachycardia could lead to acute . . .