Shirley is a 76yo female who presents to your office for evaluation of chest pain that has been going on for the past 4 days.

Shirley is a 76yo female who presents to your office for evaluation of chest pain that has been going on for the past 4 days. She states she occasionally does get chest pain now and again, but she noticed that over the past 4 days, when walking up the stairs, or going on her morning walk to get coffee with her girlfriends, she develops a central chest pressure and pain. When she stops walking, and rests, the pain completely resolves. When asked to point to where her pain is she points to the are above her left breast. She states it radiated to her left shoulder, and occasionally gets “a strange tingling” in her left arm. She denies any fever, chills, nausea, vomiting or diarrhea. Denies cough, occasional shortness of breath; but not new for her. She denies headaches or feeling like she is dizzy, or going to pass out. She denies any history or Family history of PE or DVT. She used to smoke 1PPD of cigarettes for 30 years, but quit at age 65. She denies any arm or leg swelling.

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