You are asked to evaluate a 55-year old Caucasian woman who presents to the Emergency Department with the chief complaint of chest pain for several hours. Other than that, she denies past medical or surgical conditions, takes only hormone replacement therapy, and has no known drug allergies.
Social history reveals that the patient is married, has three children, and works as an accountant.
On physical exam, the patient appears to be in mild discomfort due to chest pain, but otherwise appears normal. Head and neck, lung, heart, and abdominal exams are normal. An EKG is performed, which shows nonspecific T-wave changes in the lateral leads. This woman, who presented with severe chest pressure radiating to her back, has an elephant sitting on her chest. The presence of an elephant sitting on the chest is pathognomic for this disorder, and solidifies the diagnosis, which is often missed by clinicians who are not trained in its detection.