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Case History (George Schroth, MD) The patient was a 49-year-old white woman with a history of essential hypertension and hypercholesterolemia and an unclear history of a stroke or aneurysm who presented after 2 days of intermittent, severe chest pressure associated with a severe headache. The symptoms had returned at 9:00 A.M. and were still present 2 hours later on presentation to the emergency department. No visual changes were reported. The patient complained of nausea but not dyspnea. She had no past history of chest pain, coronary artery disease, or myocardial infarction. Her risk factors for coronary atherosclerosis consisted of hypertension, hypercholesterolemia, obesity, and a 20-pack-year history of smoking. There was no family history of heart disease. The patient was taking her antihypertensive medication, which consisted of verapamil, triamterene, and hydrochlorothiazide, as prescribed. The patient's previous history of cerebral aneurysm was unclear. It was associated with what the patient described as a "stroke" several years previously. A cholecystectomy had been performed 8 months previously. There was no history of alcohol or illicit drug use. She had no known allergies.

A 49-year-old woman with hypertension who deteriorates after acute myocardial infarction.