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A 55-year-old man presents to the clinic with complaints of chest p...

Question

A 55-year-old man presents to the clinic with complaints of chest pain. He states that for the last 5 months he has noted intermittent substernal chest pressure radiating to the left arm. The pain occurs primarily when exercising vigorously and is relieved with rest. He denies associated shortness of breath, nausea, vomiting, or diaphoresis. He has a past medical history of HTN and hyperlipidemia. He is taking atenolol for his high blood pressure and is eating a low-cholesterol diet. His family history is notable for a father who died of MI at 56. He has a 50 pack-year smoking history and is currently trying to quit. His physical examination is with normal limits with the exception of his BP of 145/95. His HR is 75.

What is the likely diagnosis?
What is the most common causes of this disease? What is the pathogenesis of his symptoms?
What are the patient’s risk factors?
What EKG finding would be concerning? What would be reassuring?
Would you call EMS about this pt? Why or Why not? If not, what other symptoms would he need for you to call?

Aagaard, E. A. (2003). Blood Disorders. In S.J. McPhee, V.R. Lingappa, & W.F. Ganong (Eds.), Pathophysiology of disease. An introduction to clinical medicine. New York: Lange Medical Books/Mc Graw-Hill

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* What is the likely diagnosis?
Ans: The chest pain may be related to cardiac, pulmonary, vascular, GI, and musculoskeletal problems. Patient’s family history suggests that it may be associated with heart disease. Based on the specific symptoms observed in patient such as intermittent chest pain which is substernal pressure radiate to arm especially left, primarily brought by exercise and subsides after rest, so the stable angina is most likely diagnosis (Abrams, J. 2005). These symptoms may also be associated with aortic stenosis and myocardial ischemia but these diseases accompanied with shortness of breath, dizziness, nausea or diaphoresis but patient denied about these.

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