An 81-year-old retired male mathematics instructor had relocated to South Florida and came to a generalist for an initial evaluation. He had been inactive physically but considered himself to be in fairly good health. On detailed questioning, he admitted to having transient episodes of dyspnea lasting 2 to 4 minutes brought on by emotional stress. These attacks of transient dyspnea were considered to be a variant of angina pectoris and a rare isolated manifestation of transient coronary arterial vasoconstriction (ie, not the classic symptoms of precordial pain or pressure). He had no nocturnal symptoms.

Physical examination revealed the following: weight 212 lb (95.4 kg), height 5 ft 10 in (1 m 78), blood pressure 155/80 mm Hg in the right arm, and pulse 76/min. On auscultation, there was an S4 gallop, the aortic second sound was accentuated and...

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