Case history
Case history
A 50-year-old man with type 2 diabetes presents with crushing substernal chest pain. He is taking metformin, glipizide, lisinopril, and atorvastatin. He has mild obesity and has a 20 pack-year history of smoking. Mild left-sided chest pain occurred 2 weeks ago while mowing the lawn. The pain lasted for only a few minutes and resolved with rest. Today more severe chest pain occurred while mowing the lawn, accompanied by shortness of breath and sweating.
Other presentations
In most patients, chest pain is the primary presenting symptom of coronary artery disease. In patients with diabetes, who often suffer from neuropathy and loss of sensation, ischaemia may occur with no associated pain. Other patients may present with atypical symptoms, including shortness of breath, nausea, vomiting, epigastric pain, or arm numbness. Women also tend to have more atypical presentations compared with men. Presentations of other forms of cardiovascular disease may include symptoms of claudication or stroke.
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