Can you edit the history of present illness for a 41-year-old male with post‑traumatic stress disorder, remote angina, intermittent hypertension (not on medication) who presented to the emergency department with acute right‑sided chest pain that began one hour ago, evolving from dull pressure to sharp 8/10 pain radiating to the neck, right arm, and back with fingertip numbness, worsened by deep inspiration, arm elevation and shoulder movement and partially relieved by arm rest, without palpitations, nausea, vomiting, diaphoresis, headache, fever, cough or recent illness, with a prior negative treadmill stress test, occasional post‑coital chest discomfort, taking escitalopram and buspirone, heavy alcohol use, vital signs: temperature 36.6 °C, pulse 66 bpm, respiratory rate 22/min, blood pressure 137/85 mm Hg, SpO₂ 96 % on room air, weight 127 kg?

Edited History of Present Illness

[PATIENT] is a 41-year-old male with PTSD, remote angina, and intermittent hypertension (not on medication) who presented to the emergency department with acute right-sided chest pain that began one hour prior to arrival. The pain evolved from dull pressure to sharp, constant discomfort rated 8/10 in intensity, radiating to the neck, right arm, and back with associated fingertip numbness. 1

Pain Characteristics

The patient described the pain as both dull and sharp in quality, constant with episodes of sharp intensification. 1 The pain was exacerbated by deep inspiration, arm elevation, and shoulder movement, and was partially relieved by arm rest. 1 The patient reported it hurt to breathe deeply and felt hot since onset. 1

Associated and Absent Symptoms

The patient denied palpitations, nausea, vomiting, diaphoresis, headache, fever, cough, or recent illness. 1 No cramping or spasm was reported. 1

Relevant History

The patient has a remote history of angina with a prior negative treadmill stress test. 1 He reported occasional chest pain post-intercourse that resolved spontaneously. 1 He has no known history of diabetes or heart failure. 1 The patient is a heavy alcohol user and denies tobacco use. 1

Medications

Current medications include escitalopram and buspirone for anxiety and PTSD. 1, 2 The patient did not attempt aspirin or nitroglycerin prior to arrival. 1

Vital Signs on Admission

• Temperature: 36.6°C (oral)
• Pulse: 66 bpm
• Respiratory rate: 22/min
• Blood pressure: 137/85 mmHg (right arm, automatic, sitting)
• SpO₂: 96% on room air
• Weight: 127 kg (280 lb) 1

Clinical Context

The pain onset occurred while sitting in a truck without physical activity. 1 The pain worsened with movement such as lifting the arm or sitting up, and radiated to the back and down the back of the palm. 1

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Key Clinical Features: The right-sided location, pleuritic quality (worsening with deep inspiration), positional exacerbation, and radiation pattern are atypical for acute coronary syndrome but do not exclude it. 1, 3 The sharp, pleuritic nature and positional worsening raise consideration for pericarditis, musculoskeletal causes, or pulmonary pathology. 1, 3, 4 However, the patient's cardiovascular risk factors (age 41, male, hypertension, remote angina history, obesity) and radiation to the arm mandate exclusion of acute coronary syndrome despite atypical features. 1