Case history/Examination:
A 41-year-old gravida 6 para 3 female presented to the emergency
department with a chief complaint of chest pain. Pain started two hours
prior to presentation, was dull, left sided, substernal, radiated to her
left arm, and with a severity of 7/10. One month prior to presentation
the patient was complaining of an abnormal uterine bleeding and was
started on oral norgestimate/ethinyl estradiol pills.
The patient has no significant past medical history. Her social history
is significant for smoking ½ a pack per day for the past 10 years. Her
family history is not significant for premature coronary artery disease
or thrombosis. Her past surgical history is significant for dilatation
and curettage two weeks prior to presentation. Home medications include
daily oral norgestimate/ethinyl estradiol pills. Her only cardiac risk
factors were smoking and the use of oral contraceptives. Upon arrival to
the emergency department the patient was vitally stable. Her physical
exam was noncontributory. Cardiac and lung exams were unremarkable.