CASE 1: (pretest probability of significant CAD: 56%)
A 62-year-old male complains of substernal chest pain that he describes as a dull ache lasting 5-10 minutes. The pain occurs at rest, but is relieved with SL NTG. The pain radiates to his left shoulder, but he has no other associated symptoms. He has had “several” episodes over the past 1-2 months, but they seem to be getting more frequent over the last few weeks.
He is a nonsmoker.
Family history is negative
PMH: hypertension
Meds: HCTZ, NTG prn, lisinopril, aspirin
ECG: NSR without ischemic changes.

CASE 2: (pretest probability of significant CAD: 98%)
A 70-year-old male complains of precordial pressure-like chest pain with exertion. The pain does not radiate, but is associated with shortness of breath. The pain lasts 10-15 minutes, resolving with rest or SL NTG. Symptoms have been gradually worsening over the last 6 months. He smokes 1 ppd. Family history is negative.
PMH: DM with proteinuria, hyperlipidemia.
Meds: metformin, aspirin, glipizide, lisinopril, simvastatin
ECG: NSR with occas PVCs. Old inverted T waves in V1-2

CASE 3: (pretest probability of significant CAD: 6%)
A 52-year-old female complains of burning substernal chest pain occurring intermittently during the day. The pain has no relation to exertion or any emotional stressors, lasts 1-2 minutes, and resolves spontaneously. The pain does not radiate and has no associated symptoms. She smokes ½ to 1 ppd.
PHM: HTN
Meds: HCTZ
ECG: NSR with occas PACs. No ischemic changes.