A Woman with Headache and Chest Pain

A 34 y/o woman, with a past medical history significantfor asthma, newly diagnosed hypertension, and migraines,presented to the emergency department with complaintsof sudden onset chest pain. She was an active youngwoman, who up until the day of admission, had been ableto run several miles without chest pain or shortness ofbreath. Symptoms began the morning of admission, whenthe patient reported that she developed a migraineheachache, with typical right-sided temporal pain. Afteradministering an injection of Sumatriptan, her headacheresolved. Soon thereafter, she noted 5/10 substernal chestpressure occurring suddenly at rest, without radiation toher arms or jaw. It was not associated with nausea,vomiting, diaphoresis or shortness of breath. The patientstated that she had never experienced this type of painbefore, which alarmed her enough to come to thehospital. One sublingual nitroglycerin, given in the ED,complete relieved her symptoms.