A 90-year-old man with high blood pressure, an extensive smoking history, and longstanding medically managed nonobstructive coronary artery disease presented to the emergency department with a 1-week history of worsening intermittent nonexertional chest discomfort that felt different from his typical angina. Pain radiated to his scapula. He had no other symptoms. His blood pressure was 160/90 mm Hg in both arms, and his pulse rate was 70 beats/min. His cardiac, pulmonary, and neurologic examinations yielded normal results; his electrocardiogram results and troponin levels were normal; and his D-dimer level was elevated.

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