Editor’s note:
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A 53-year-old man with obesity has been suffering from chest pain for an hour and is brought to the emergency room by the emergency medical services. The patient describes the pain as sharp, constant, non-radiating and with an intensity of 7 out of 10. The pain started 10 minutes after he finished his lunch while he was watching television. He reports no particular aggravating or alleviating factors. The emergency medical services personnel gave him nitroglycerin, which provided him with slight relief of symptoms.
The patient works from home and sits in a chair for 8-12 hours a day. He has also suffered from a nagging, dry cough for many years. He has also reported frequent fevers and night sweats for several months. He attributes his symptoms to “the flu,” which he probably caught from his children. He tested positive for COVID-19 about 6 months ago, but had no symptoms and has since been vaccinated.
He has smoked a pack of cigarettes a day for 20 years and has been using medical marijuana to satisfy his appetite for 6 months. He does not use any illegal substances.
He denies nausea, vomiting, hematemesis, hemoptysis, diarrhea, redness or swelling of the legs, bowel or bladder discomfort, dizziness, and weakness. 6 months ago he had lost some weight and had difficulty swallowing, which improved when he switched to healthier, softer foods such as smoothies and milkshakes and began eating small meals throughout the day instead of three large meals.
The patient has a history of coronary artery disease, hypertension, type 2 diabetes, and gastroesophageal reflux disease (GERD). He reports that he is very compliant with his medications. His blood pressure is well controlled with amlodipine and lisinopril. He uses sliding-dose insulin at home, and his last A1c was 8% approximately one year ago. He takes antacids as needed to relieve the symptoms of his GERD. Due to a busy schedule, he has been unable to see his primary care physicians for the past year.
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The views expressed above are those of the author and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Dushyant Singh Dahiya, Farah Wani, Asim Kichloo. A smoker with chest pain after eating – Medscape – 28 August 2024.
