Index of Suspicion: Case 1: fatigue, shortness of breath, and chest pain in an adolescent boy. Case 2: poor feeding and weight gain, tachypnea, and vomiting in a neonate. Case 3: afebrile seizures after a bout of diarrhea in a 2-year-old girl.

摘要

A 15-year-old boy presents with a 6-day history of progressive generalized weakness, shortness of breath, and chest pain that he describes as squeezing in nature whenever he lies fiat. He has had difficulty sleeping and says that he feels that his "heart is getting bigger." Since yesterday, his symptoms have worsened, and he has developed pain in his left arm and abdomen. He is more comfortable sitting up. He denies any change in weight, night sweats, visual disturbances, neck stiffness, or rashes. His past medical and family history contain no findings of note. He is not taking any medication and denies use of stimulants or illicit drugs.