Dan G. ,a 65-year-old man,presents to your primary care office for the evaluation of chest pain and left-sided shoulder pain.Pain begins after strenuous activity,including walking.Pain is characterized as dull,aching;8/10 during activity,otherwise 0/10.Began a few months ago,intermittent,aggravated by exercise,and relieved by rest.Has occasional nausea.Pain is retrosternal,radiating to left shoulder,definitely affects quality of life by limiting activity.Pain is worse today;did not go away after he stopped walking.BP 120/80.Pulse 72 and regular.Normal heart sounds,S1 and S2,no murmurs.Which of the following differential diagnoses would be most likely?

Question

Quizplus · Accepted Answer

The presentation of exertional chest pain radiating to the left shoulder and relieved by rest is classic for angina pectoris, which is associated with coronary artery disease. The fact that the pain is also limiting the patient's activity and not relieved by stopping the activity further supports this diagnosis. Musculoskeletal chest wall syndrome and esophageal motor disorders could also cause chest pain, but they typically do not radiate to the left shoulder or worsen with exertion. Acute cholecystitis would present with right upper quadrant abdominal pain and would not be expected to cause chest pain radiating to the shoulder.

Dan G ,A 65-Year-Old Man,presents to Your Primary Care Office for for the Evaluation