Female patient (41) with no diagnosed chronic diseases, pre | Figure 1

DRCOCCUS

Medical Student

Female patient (41) with no diagnosed chronic diseases, presenting chest pain in the last 4 weeks, intensity 8/10, occurred at night and radiates to the left arm, reports feeling palpitations occasionally. No syncope, headache, or SOB.

She considers herself an anxious person but has never received any medical follow-up. Pain improves only a little with ibuprofen 400 mg/daily but the symptoms persist.

E: HR 85 BPM RR 12 PM BP 110/70 mm/Hg Temp 37.5 °C

The examination of the head is normal, with cranial pairs without alterations. At cardiac auscultation a discrete deviation of the apex beat is perceived, no other abnormalities. Chest is auscultated normally and does not trigger pain on palpation. Radial pulses present and synchronized with the heartbeat. Rest of exploration is normal.

LABS: Blood chemistry, thyroid tests, and blood biometry, in normal parameters. Presents Hypertriglyceridaemia 320 mg/dL (3.2 mmol/L) and normal cholesterol values. She has a chest x-ray on her cell phone that looks pretty normal (Don't have the picture) and this EKG.

Any opinion about the EKG?

Any other study to consider for this case?

I appreciate your attention and all your opinions. Regards

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