66-Year-Old Man With Long-standing Intermittent Chest Pain

Abstract

Address reprint requests and correspondence to Joseph L. Blackshear, MD, Division of Cardiovascular Diseases, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (e-mail: blackshear.joseph @mayo.edu). A 66-year-old man was referred to our institution for evaluation of long-standing chest pain that had recently increased in frequency. He had experienced a squeezing heaviness in the central portion of his chest with associated tingling of his left arm at various times during the past 10 years. The symptoms occasionally developed during his morning walk; however, episodes also occurred with no physical activity, and rest-related and exerciserelated episodes occurred with equal frequency. At presentation, he reported onset of chest discomfort within 15 to 20 minutes after beginning his daily 3-mile walk. Discomfort was relieved after 90 seconds of rest. The episodes of chest discomfort had increased in frequency from only once weekly to every other day to daily within the previous 6 months. He had a history of hypertension and hyperlipidemia and a family history of coronary artery disease. During the past 10 years, 3 cardiovascular evaluations, including exercise thallium scintigraphy and coronary angiography, yielded unremarkable results. The symptoms persisted despite the use of atenolol (25 mg/d).