Mr. T is a 55-year-old man with a history of Pre-diabetes mellitus (DM) and hypercholesterolemia who presents with a chief complaint of “pressure on the chest” that lasted 5 mins. Mr. T was in his usual state of health until three days ago when he felt a gradually increasing pressure on his chest as he was shoveling snow at 7:30 am. The discomfort caused him to immediately stop shoveling and the pain resolved on its own with rest within 2 to 3 minutes, and he has not experienced any discomfort since then. Mr. T describes the pain as being a heaviness on his chest as if there was “an elephant sitting on his chest” and rated the discomfort as being an 8 out of 10. When asked to point out where point to the specific region of heaviness, Mr. T
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T states that in addition to the heaviness, he also had trouble breathing, was sweating and felt nauseous for those 5 minutes. Furthermore, he describes feeling pain in his jaw and shoulders, both of which he rates as being 6 out of 10. He claims the pain in his jaw and shoulders subsided with the disappearance of his chest discomfort. Since this episode was short-lived, Mr. T did not take any medications for it. Additionally, he states that standing outside in the cold worsened his discomfort and coming back inside his home alleviated the discomfort. Mr. T claims that such episodes of discomfort, with the exact same symptoms and duration, happened to him twice earlier this year on separate occasions while he was shoveling snow – once sometime in early January 2018 and once sometime in mid-February 2018. The first two times he attributed the heaviness in his chest to performing unusually increased physical activity. However, since this has happened a third time, he decided to seek out medical care to investigate the cause of these episodes. Mr. T lives alone with his wife in a house located in a suburban neighborhood of New Jersey, that receives a lot of snow in the winter months and he usually is solely responsible for shoveling the snow off their drive way. He worries that if such episodes continue he may have to ask other friends and family for help with the shoveling or find a way to hire someone to do the job. He states that he would like to avoid the financial
T states that in addition to the heaviness, he also had trouble breathing, was sweating and felt nauseous for those 5 minutes. Furthermore, he describes feeling pain in his jaw and shoulders, both of which he rates as being 6 out of 10. He claims the pain in his jaw and shoulders subsided with the disappearance of his chest discomfort. Since this episode was short-lived, Mr. T did not take any medications for it. Additionally, he states that standing outside in the cold worsened his discomfort and coming back inside his home alleviated the discomfort. Mr. T claims that such episodes of discomfort, with the exact same symptoms and duration, happened to him twice earlier this year on separate occasions while he was shoveling snow – once sometime in early January 2018 and once sometime in mid-February 2018. The first two times he attributed the heaviness in his chest to performing unusually increased physical activity. However, since this has happened a third time, he decided to seek out medical care to investigate the cause of these episodes. Mr. T lives alone with his wife in a house located in a suburban neighborhood of New Jersey, that receives a lot of snow in the winter months and he usually is solely responsible for shoveling the snow off their drive way. He worries that if such episodes continue he may have to ask other friends and family for help with the shoveling or find a way to hire someone to do the job. He states that he would like to avoid the financial