Case 1:

Mr. JO is a 54 y/o male with a 10 year history of HTN and a 30 pack year history of smoking who presents to your clinic with occasional substernal chest pain while tossing baseball with his grandson. These episodes seem to occur when he is tossing the ball for longer periods of time, but the pain goes away after he stops exerting himself. He has never had this pain before, and he admits to being “out of shape.” He states that he occasionally has shortness of breath with the chest pain, but he denies any other associated symptoms. The chest pain does not radiate. He is worried that the pain could be his heart because “my dad died before he was 50 from a heart attack.” He is currently without any pain.

His medical history is unremarkable except as noted above. He is married with three children and 7 grandchildren. He denies any alcohol use. His only medication is Atenolol 50mg, once daily. He admits that he seldom takes it.

On PE, his Vital Signs are as follows: P 100, RR 18, BP 160/90, T 37.2C
His HEENT is normal; there is no elevation of JVP. His lung and abdominal exam are normal with the exception of obesity. His heart exam is notable for an S4. There are no bruits and no edema on peripheral vascular exam. His musculoskeletal exam is normal as well. He asks you, “Doc, am I going to have a heart attack?”