Case synopsis

A 77-year-old male chef enters your hospital with the following complaints/characteristics

• Progressively worsening exertional angina (walking 50 m)
• One episode of pain with emotion & 5-min episode at rest; no recurrence
• ECG: 1 mm horizontal ST-segment depression in leads II, III & AVF
• In-hospital medications: aspirin, nitrate, diltiazem, LMWH
• CKMB & troponin negative on arrival (troponin < 0.01 ng/ml)
• Obese: BMI 32 kg/m2
• Non-insulin-dependant diabetes mellitus & mild asthma