4.7 of 14 Ratings
A 72-year-old man with a history of chronic kidney disease presents to his primary care physician complaining of recurrent chest pain with activity. The patient used to have chest pain when he mowed his lawn. Now he gets chest pain whenever he walks short distances such as to get his mail. The pain resolves on its own when the patient sits and rests. His temperature is 98.2°F (36.8°C), blood pressure is 157/98 mm Hg, pulse is 80/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for an obese man who is in no distress. An initial ECG is unchanged from a previous ECG. The patient's first troponin is 0.06 ng/mL which is unchanged from previous troponins. Which of the following is the most likely diagnosis?
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A 50-year-old woman with no significant medical history comes to your office complaining of "chest pain attacks." She says that these attacks tend to occur in the middle of the night or early morning, and only last 15-20 minutes. She describes the pain as sharp and substernal. You perform an electrocardiogram (EKG), which is unremarkable. Suspecting the diagnosis, you perform another EKG following administration of ergonovine, and observed transiently the following (Figure A). Which of the following conditions has a pathophysiology most similar to this patient's condition?
A patient with crushing chest pain who has an blockage in the left anterior descending (LAD) artery
A hypertensive patient who presents with an intracranial bleed and hemiplegia
A smoker with diabetes who presents with pain in his calves while walking
A woman who complains of blue discoloration of her fingers when she walks outside in the winter
A pregnant woman with a history of deep vein thrombosis who presents with shortness of breath and filling defects on CT angiography