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New England Journal of Medicine Case Records: A 41-Year-Old Woman with Recurrent Chest Pain

In This Article

  • A 41-year-old woman presented to Mass General with chest pain
  • 1 year before presentation, the patient had transient tightness in the chest and shoulder on the left side
  • Five days before presentation, acute substernal chest pain developed
  • The day before presentation, substernal chest pain with radiation to the jaw and shoulders recurred

A Case Record of The Massachusetts General Hospital began like this:

“A 41-year-old woman presented to Massachusetts General Hospital with chest pain. Approximately 1 year before presentation, the patient had had transient tightness in the chest and shoulder on the left side that had prompted a referral to outpatient physical therapy. Five days before presentation, while the patient was packing for a flight to Boston, acute substernal chest pain developed; the pain radiated to the jaw and shoulders and was accompanied by dyspnea and by a feeling of needing to belch. These symptoms lasted 1 hour and then spontaneously resolved, and she attributed them to fatigue.

On the day before presentation, substernal chest pain with radiation to the jaw and shoulders recurred after the patient had been walking, and the pain gradually resolved after a few hours. Before dinner on the evening of presentation, the pain recurred and was associated with light-headedness. The patient attended dinner but had persistent pain, along with dyspnea. She presented to the emergency department of this hospital."

After reading the full case record, what would be your clinical diagnosis? Comment below.

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