A 35-year-old Caucasian female presents to the ER with Chest Pain of six hours duration. The pain is a tight and heavy sensation in the retrosternum and neck. She also is mildly short of breath and has to take sighing breaths to help her breathing. She describes some tingling and numbness in both her hands. No radiation of pain to the jaw or back.

Patient is a nurse with two children ages ten and five-years-old. She is very active but does not exercise daily. She has been unrestricted in her activities till now. The pain started while working at the hospital. She has been unwilling to exert herself after that.

She does NOT have Diabetes, Hypertension, Hyperlipidemia, FH of premature CAD and she doesn’t smoke. She is not overweight. Examination is normal.


1.What more information in the H&P would be useful?

2.What is the differential diagnosis?

3.How would you evaluate this patient further?