A Change of Heart

doi:10.1056/NEJMcps0903023

Volume 361:1010-1016		September 3, 2009		Number 10

A Change of Heart

Thomas T. Tsai, M.D., M.Sc., Brahmajee K. Nallamothu, M.D., M.P.H., Abhiram Prasad, M.D., Sanjay Saint, M.D., M.P.H., and Eric R. Bates, M.D.

Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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In this Journal feature, information about a real patient ispresented in stages (boldface type) to an expert clinician,who responds to the information, sharing his or her reasoningwith the reader (regular type). The authors' commentary follows.

A 57-year-old teacher with a history of hypertension presentedto an urgent care center with nonradiating chest pressure andlight-headedness. The chest pressure had begun soon after shearrived at work that morning, when she was physically threatenedby a parent of one of her fifth-grade students. Her symptomsimproved with rest immediately after the event but then worsenedby the end . . . [Full Text of this Article]

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From the Denver Veterans Affairs (VA) Medical Center and the Department of Internal Medicine, University of Colorado — both in Denver (T.T.T.); the Health Services Research and Development Center of Excellence, Ann Arbor VA Medical Center (B.K.N., S.S.); and the Department of Internal Medicine, University of Michigan (B.K.N., S.S., E.R.B.) — both in Ann Arbor; and the Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN (A.P.).

Address reprint requests to Dr. Tsai at the University of Colorado Denver, Cardiology Section (111B), 1055 Clermont St., Denver, CO 80220, or at thomas.tsai@va.gov.