The review of our patient's daily activities is an effective method of eliciting the history of angina pectoris. While he initially dismissed his symptoms as indigestion, further questioning of our patient revealed that he had been avoiding heavy exertion for over a year. For example, he stopped doing heavy yeard work, as it caused more intense lower chest discomfort with radiation to his jaw and upper arms. The patient also initially ascribed his symptoms to the stress of seeking a new job. However, specific examples of emotional upset, such as the recent heated argument with his teenage son, clearly caused his symptoms. Whenever he had discomfort, several minutes of rest relieved the symptoms.

By reviewing his daily activities, it became clear that he had modified his lifestyle to avoid his symptoms of angina pectoris. It also became clear that the patient was exercising much denial and that he was quite concerned about his health.

While the remainder of the history of his present illness was unremarkable, review of his risk factors for coronary artery disease was revealing. He had smoked a package of cigarettes per day for thirty years and had been told that he had hypertension in the past. He also ascribed this to stress and did not follow up. His father and a brother had acute myocardial infarctions in their early fifties. His cholesterol level is unknown.

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