Gary is a 55-year-old white man who began to experience chest discomfort while walking his dogs...

Gary is a 55-year-old white man who began to experience chest discomfort while walking his dogs with a friend. He tells his friend it is indigestion, but after his pain becomes a crushing sensation that begins to spread upward into his neck and lower jaw his friend called 911 on his cell phone.

When Gary arrives at the emergency room, staff collect his medical history which includes poorly controlled hypertension, type 2 diabetes, and hyperlipidemia (high cholesterol). His father died from a “heart attack” at age 50. He has smoked a pack per day for the last 30 years, and has a sedentary job as a bus driver. He tells you that he tries to make up for the sedentary nature of his job by getting at least 30 minutes of walking done, usually at a brisk pace with his dogs, every day. Despite his regular physical activity, Gary’s BMI is 30.5.

• What do you expect Gary’s diagnosis to be? Is there another diagnosis that Gary could be experiencing? Explain your rationale, and describe what additional information you would need in order to decide.

• What type of pain is Gary experiencing? Explain your rationale.