Case 27-1990

Presentation of Case A 63-year-old woman was admitted to the hospital because of severe substernal pain. The patient was in a stable state of health until 2 1/2 years earlier, when chest pain developed while she was walking uphill and disappeared after several minutes of rest. A physician prescribed nitroglycerin, but chest pain did not recur until five months before entry, while she was watching television, with radiation to the left arm. She took an antacid without relief and went to sleep; the pain was still present when she awoke the next morning, and she was admitted to the hospital. . . .