Case Presentation
A 62-year-old Hispanic woman with atypical chest pain and mild shortness of breath presents to a cardiologist as a new patient. She is noted to have recurring, fleeting, dull, and nonradiating pain over the central chest, lasting 5-10 minutes per episode. The episodes appear to be brought about by high-stress environments, and the patient reports being under increased stress due to family illness and concerns about COVID.
The patient has a family history of heart disease; her father died of myocardial infarction (MI) at age 53 years. Her medical history is significant for high cholesterol and hypertension. The hypertension is well-controlled with an angiotensin receptor blocker. She is on no other medications and denies past or current tobacco, alcohol, or recreational drug use.
The patient's vital signs at presentation are normal, as follows:
Blood pressure: 128/78 mm Hg
Heart rate: 74 beats/min
Respiratory rate: 18 breaths/min
Temperature: 98.4°F
Oxygen saturation: 99% on room air
The physical examination is unremarkable. Laboratory studies reveal the following:
A1c: 5.8%
Thyroid-stimulating hormone (with creatinine values: within normal range)
Total cholesterol: 209 mg/dL
High-density lipoprotein cholesterol (HDL-C): 52 mg/dL
Low-density lipoprotein cholesterol (LDL-C): 128 mg/dL
Triglycerides: 145 mg/dL
Non–HDL-C: 157 mg/dL
Management
The 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain (
