My chest is hurting




HISTORY


86 yo F h/o HTN, HLD, recurrent UTI who presents to the hospital with one day of left sided chest pain radiating to her left arm. She was in her normal state of health until yesterday when the chest pain began. She is very active and walks 2 miles a day, and has not had chest pain with exertion. She lives with her husband who was recently diagnosed Stage IV lung cancer.


No nausea, vomiting, headache, blurry vision or shortness of breath.


VITALS


T 97 HR 93 BP 137/77 RR 13 SpO2 98% on room air


EXAM


AOx3, thin, appears younger than age, mild distress due to chest discomfort

No lymphadenopathy, no prominent jvd

S1, S2, 2/6 systolic murmur

Lungs clear

Abdomen soft, nontender

no lower extremity edema


POCUS cardiac exam


Parasternal Long View


Parasternal Short View


Apical 4 chamber view


LABS


WBC 6, Hgb 11, Plt 240k

BUN 19 Cr 1.0

Troponin 1.5 --> 3

BNP 350


EKG


She was taken to the cath lab which showed mild, non-obstructive coronary artery disease.


What is the diagnosis?


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