A 51-year-old male has come to the health clinic for his annual physical exam. After exerting himself by walking from his car to the clinic, he experienced substernal pain, discomfort in his left shoulder, and his jaw.

These symptoms lasted for 2-3 minutes and then subsided with rest.

He mentions that this has been a frequent occurrence over the past few months with similar levels of exertion.

What is the nurse likely to suspect he is experiencing?

Choice A rationale
Sinus tachycardia at a rate of 110 beats/min is a normal response to exercise. During a stress test, the heart rate will naturally increase as the body’s demand for oxygen increases. A heart rate of 110 beats/min is within the expected range during moderate exercise.
Choice B rationale
An increase in blood pressure from 134/68 to 150/80 mm Hg is a normal response to exercise. During a stress test, blood pressure will naturally rise as the heart works harder to pump blood to the muscles. This increase is within the expected range during moderate exercise.
Choice C rationale
Feeling tired during a stress test on a treadmill is a normal response to exercise. Fatigue can occur as the body’s energy stores are used up during physical activity. However, if the patient reports extreme fatigue or other symptoms such as chest pain or shortness of breath, it may indicate a problem.
Choice D rationale
Inversion of T waves on the electrocardiogram during a stress test is a sign of myocardial ischemia, a condition in which the heart muscle is not getting enough oxygen. This could indicate the presence of significant coronary artery disease and is a finding that would necessitate immediate action.

Choice A rationale
Stable angina is characterized by chest pain that occurs with exertion and is relieved by rest. If a patient with angina pectoris is experiencing chest pain at rest and needs to take three nitroglycerin pills to relieve the pain, this is not typical of stable angina.
Choice B rationale
A full-blown acute myocardial infarction (MI), or heart attack, typically presents with severe chest pain, shortness of breath, and other symptoms. While chest pain at rest could be a symptom of an MI, other symptoms would likely be present.
Choice C rationale
Unstable angina is characterized by chest pain that occurs at rest, is severe and prolonged, and is not relieved by nitroglycerin. Therefore, a patient with angina pectoris who is experiencing chest pain at rest and needs to take three nitroglycerin pills to relieve the pain could be experiencing unstable angina.
Choice D rationale
Pulmonary embolus, a blockage in one of the pulmonary arteries in the lungs, typically presents with sudden-onset shortness of breath, chest pain that may become worse upon deep breathing or coughing, and other symptoms. Chest pain at rest could be a symptom of a pulmonary embolus, but other symptoms would likely be present.