Cardiology Case Challenge: Severe Recurring Chest Pain in a 50-Year-Old Man With Cancer

Priyanka Ghosh, DO


April 12, 2023

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 50-year-old man presents to the emergency department (ED) with chest pain. His past medical history includes gastroesophageal reflux disease and stage IIIB cecal adenocarcinoma, which was diagnosed 3 months earlier and required right hemicolectomy. He was recently evaluated by his oncology team and started a 3-month chemotherapy regimen with capecitabine and oxaliplatin 3 days before his presentation to the ED. Owing to worsening reflux symptoms during this time, he also began taking over-the-counter omeprazole.

The patient describes the pain in the middle of his chest as pressurelike and burning; it first occurred while he was walking through the grocery store. He rates the discomfort as a 7 out of 10 on the pain scale, with symptoms radiating to his left jaw and left arm. He has never experienced these symptoms before, nor did he have any viral illness that preceded these symptoms. The pain improves with rest, and he has not taken any medications for relief. He does not report shortness of breath, palpitations, lightheadedness, diaphoresis, and nausea. He has no history of tobacco use, reports minimal alcohol consumption during social gatherings, and does not use illicit drugs.


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