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A 55-year-old man who recently emigrated from Asia comes to an urgent care center with a complaint of chest pain. He states that for the past few months he has had occasional tightness in his chest that seems to radiate to his left arm. He further notes that the pain seems to be most frequent when he is vigorously exercising or working in the yard and that when he sits down to rest the pain seems to subside. He does not experience any shortness of breath, unexplained nausea, vomiting, or diaphoresis. His medical history includes hypertension and hyperlipidemia. He is taking medication for his hypertension and is modifying his diet to reduce his serum cholesterol. He notes that his father died of myocardial infarction at age 56. He has smoked one to two packs of cigarettes on a daily basis for the past 35 years and is currently trying to stop using nicotine patches. His physical examination is unremarkable with the exception of blood pressure, which is 145/95 mm Hg with a heart rate of 82 bpm.
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