Pretty stunning. He’s young and, despite some tobacco and a generous BMI, he seems healthy. He eats whole foods and is physically active. He does not have diabetes or hypertension.
Last night he was asking about whether a stress test could have made a difference. Two years prior, he experienced symptoms consistent with atypical angina. He had two episodes of chest pain, both associated with activity, but not regularly reproducible. My friend discussed these symptoms with a doctor who did an initial work-up to get a Framingham risk score but my friend never followed up. So the question my friend had was simply, “Should an exercise-stress test have been done on my initial presentation?”
So let’s look at the data. During the hospitalization a lipid panel was done which allows us to calculate his Framingham Risk:
- Definite or classic angina — Substernal chest discomfort characterized by all of the following characteristics: a typical quality and duration, provocation by exertion or emotional stress, and relief by rest or nitroglycerin
- Probable or atypical angina — Chest pain with two of the three above characteristics
- Nonanginal or nonischemic chest pain — Chest pain with one or none of the above characteristics