Case history
Case history #1
A 50-year-old man presents with a complaint of central chest discomfort after walking for more than 5 minutes or climbing more than one flight of stairs for the past 2 weeks. The chest discomfort resolves with rest within several minutes. He is obese, has a history of hypertension, and smokes 10 cigarettes a day. His father died from a myocardial infarction (MI) at the age of 54 years. On examination, his blood pressure is 144/92 mmHg with a heart rate of 82 bpm. The remainder of his exam is normal.
Case history #2
A 60-year-old man with a history of a MI presents for follow-up. He was started on aspirin, beta-blocker, and statin therapy after his heart attack. In the past 2 weeks the patient has noted a return of chest pressure when he walks rapidly. The chest pressure resolves with sublingual nitroglycerin or a decrease in his activity level. He is a former smoker and has modified his diet and activity to achieve his goal body weight. He is normotensive on exam with a heart rate of 72 bpm. The remainder of his exam is normal.
Other presentations
Atypical locations of anginal pain include the epigastrium, neck, jaw, or arms. Exertional dyspnea, fatigue, nausea, indigestion, and light-headedness are alternative symptoms sometimes called anginal equivalents. Women, older people, and patients with diabetes may be more likely to present with atypical angina or anginal equivalents.
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