A 70-Year-Old Healthy Man With Chest Discomfort

AUTHOR:
Ronald N. Rubin, MD^1,2 —Series Editor

AFFILIATIONS:
¹Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
²Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania

CITATION:
Rubin RN. A 70-year-old healthy man with chest discomfort. Consultant. 2021;61(12):e24-e26. doi:10.25270/con.2021.12.00002

DISCLOSURES:
The author reports no relevant financial relationships.

CORRESPONDENCE:
Ronald N. Rubin, MD, Temple University Hospital, 3401 N Broad Street, Philadelphia, PA 19140 (blooddocrnr@yahoo.com)

A 70-year-old man presented to your office with a history of chest “discomfort” of several months’ duration. He is not precisely sure when it had started but knows it has been present for at least 3 to 4 months. His description of the discomfort is a “tightness and pressure sensation” rather than pain. It is located across his chest centrally and does not radiate. He has no associated shortness of breath and does not have discomfort or dyspnea at night while sleeping.

Initially, he had thought it was muscular since he is quite active in his metal working business, which requires lifting and exertion when operating his machine shops. When questioned in detail, he recognized that the pain might also be present during recreational activities. He had casually mentioned these symptoms to a friend, who had helped test the theory by jogging or running with the patient and then asking whether the discomfort was elicited. When the answer was indeed “yes,” a prompt visit to your office was arranged.

Medical history. The patient is otherwise in good health. His only major medical diagnosis is a localized Gleason score 6 prostate carcinoma, which was diagnosed 3 years ago and treated with radiation therapy for curative intent. At his latest follow-up examination, his prostate-specific antigen level was 0.

He has never smoked, has no symptoms of chronic obstructive pulmonary disease or congestive heart failure, and does not have diabetes.

Physical examination. The patient was a thin, athletic, healthy-appearing man. His vital signs were within normal limits, including blood pressure (128/82 mm Hg). Examination findings of the head, eyes, ears, nose, and throat were normal. His chest was clear to percussion and auscultation. His cardiac rhythm was regular, and there were no murmurs or gallops. The remainder of the examination was noncontributory.

Diagnostic testing. Results of a complete blood cell count and metabolic panel were within normal limits, including his glucose (104 mg/dL) and hemoglobin A1C (5.0%) levels. His troponin levels were also examined and were not elevated. Lipid analysis was pending, but prior measurements had revealed only a slightly decreased level of high-density lipoprotein cholesterol.

An electrocardiogram showed normal sinus rhythm and no ST-T abnormalities, Q-waves, or acute injury current.

Answer and discussion on next page.