Case study ( 7238 views as of October 1, 2020 )
Marco is a 47-year-old real estate agent who left a major real estate chain 2 years ago to set up his own office. He has done remarkably well, with more referrals and business than expects, and frankly, more business than he can handle on his own. He is working 80-90 hours per week, and clients phone him "at all hours". During a late morning meal break between showings, he develops an episode of crushing chest pain and shortness of breath. This is not the first time Marco has experienced these symptoms, and the restaurant staff offer to call an ambulance.
Marco is a fit, non-smoking triathlete with no family history of heart disease. He's had spells like this before, and has had four emergency department evaluations where "everything came back normal". He's been referred twice to cardiology for treadmill tests, and he paid to have a private CT-angiogram, which was normal. On his last emergency visit, it was suggested to Marco that this could "just be stress".
Marco may still benefit from another evaluation in the emergency department to consider other causes for chest pain. However, evaluation of the role of stress, anxiety and the consideration of panic symptoms would be worthwhile as well. Marco could consider seeking help from a registered dietitian or a naturopathic doctor to understand how his diet and supplements could be changed to improve his level of stress, and some therapeutic physical activity like yoga could be beneficial as well.Author: Dr. Adam Lund