Mr. Raymond's chest pain
 
Symptoms & History

Physical Findings

Stop & Think

Lab and X-Ray

Differential Diagnosis

The Disease

Treatment

Conclusions

Quiz & Evaluation

 It's obvious at this point that Mr. Raymond has coronary atherosclerosis.
  • Lousy cholesterol (we have yet to hear on his LDL and HDL, but it's a sure bet they're no good).
  • Cutaneous xanthomas noted on physical.
  • Compelling family history.
  • Smoker
So what's the big deal? 

As I am sure you picked up some time back, this is not typical angina. His pain is non-exertional. In other words, it comes without physically taxing the heart. Recall, the most recent episode occurred while he was sitting in the examining room.

What could suddenly, but transiently, cause additional narrowing of his coronary artery resulting in the anginal pain?

  

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