A patient presents to your office in distress without an appointment. He is 23 years old and is complaining of severe chest pain. He reports a family history of coronary disease, complains of frequent “heartburn,” and says he is recovering from a recent viral upper respiratory infection.

A patient presents to your office in distress without an appointment. He is 23 years old and is complaining of severe chest pain. He reports a family history of coronary disease, complains of frequent “heartburn,” and says he is recovering from a recent viral upper respiratory infection. He smokes one pack of cigarettes a day, and admits to illegal drug use in the past. On examination, his blood pressure is 138/90 mm Hg, his pulse is 126 beats per minute and regular, and he is diaphoretic. His examination is otherwise unremarkable. His electrocardiogram (ECG) shows myocardial ischemia. Which of his historical features are most suggestive that myocardial ischemia would be the cause of his symptoms?

a. Family history of coronary disease

b. History of “heartburn”

c. Recent viral upper respiratory infection

d. Smoking history

e. Drug use

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