Skill Checkup: A 71-Year-Old Man With History of Type 2 Diabetes and Related Hypertension Experiences Retrosternal Pressure

Carolyn Newberry, MD, PNS


December 21, 2022

Temporary retrosternal chest pain brought on by unusual activity or exertion suggests a cardiovascular (CV) origin in any patient. Given this patient's history of T2D and hypertension and the prevalence of cardiovascular disease (CVD) among patients with T2D, hypertension, and obesity, a cardiac cause of his distress is likely. Multiple studies have demonstrated a linear relationship between increasing hypertension and increasing CVD risk. Other studies have established increased risk for atherosclerotic CVD (ASCVD) in patients with T2D, the risk that is further exacerbated by obesity.

Given the likelihood of CVD, the rapid resolution of symptoms upon rest makes stable angina the most probable diagnosis. Less likely is acute MI because symptoms of MI tend to be more severe and longer lasting. The differences in symptom severity and duration are important clinical clues in diagnosing angina from acute MI.

Chest pain may be a symptom of CHF. However, the diagnosis is unlikely to be relevant here because the patient has no history of shortness of breath with exertion or at rest, which is a typical symptom of heart failure (HF).

None of this patient's symptoms are typical for GERD, which might instead have dyspepsia, burning sensation in the esophagus, or dry cough and throat irritation. Thus, this diagnosis is unlikely because GERD-like pain is neither triggered by exertion nor relieved with rest.


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