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.