CC: Chest PainHPI: 56 year old female with PMH of hypothyroidism, OSA, depression presents with chest pain and shortness of breath intermittently for the past two weeks. Patient states that the pain and shortness of breath are worse with exertion. The worst of these episodes was yesterday. Patient notes that she was walking with her daughter to a volleyball tournament when she experience a squeezing pain in her chest which she rated as 7/10 and noted that it radiated to the left of her neck. She described the other episodes of pain as more of a heart flutter. She notes that the pain is worse when shes feeling stressed and can be relieved with rest. She denies that the pain is associated with eating.

PMH:HypothyroidismDepressionOSA on CPAP

PSH:None

Meds:Levothyroxine Sodium Trazadone CymbaltaPantoprazole SodiumDymista

Allergies:No known medication reactions

Social History:Patient is a single mother with 1 daughter at home who works in maternal and child healthcare. Patient has never smoked but grew up in a household of passive smoke exposure. Patient notes social alcohol use (1-2drinks/month)

Family History:Mother: HTNFather: Bladder CancerMaternal Grandfather: Type II Diabetes mellitusPaternal Grandfather: MI at 65 years of age

ROS:(+): Fatigue, Palpitations, Chest pain, Dyspnea(--): Fevers, Chills, Weight change, Loss of appetite, night sweats, extremity edema, change in vision, blurred vision/diplopia, sore throat

Physical Exam:

T- 36.8 BP 103/59 HR 80 RR 18 O2 95% on RA

Gen: NAD, laying in bed, pleasant and communicativeEyes: EOMI, PERRL, Sclera anictericENMT: MMM, No oral lesions, no cervical lymphadenopathyCV: RRR normal s1s2 no m/r/g. No JVD. No peripheral edemaResp: CTAB no w/r/rGI: soft NT/ND NABSx4MUSK: moves all 4 extremities spontaneously, no peripheral edemaSkin: Warm and dry, no rashesPsych: appropriate mood and affect well groomedNeuro: AAOx3, CNII-XII grossly intactLines: PIV

Labs/Imaging:

CBC: 9.4>12.7/39.4