Our patient is a 16 year old left handed young man with a chief complaint of left chest and shoulder pain of one week's duration.
His present illness began with symptoms following intensive tennis practice. The distress increases with left arm movement, and is better when his arm is at rest. The area is also tender to palpation.
A survey of the cardiac history revealed no palpitations, shortness of breath, edema or syncope. There was also no history of rheumatic fever, heart murmur or drug use.
His only known risk factor for coronary artery disease is his father's heart attack at age fifty. He does not smoke, and has no history of hypertension. His blood glucose and lipids have never been determined.