In a patient with a history of anxiety and GERD, at what point do you push the idea that the patients symptoms just COULD be cardiac in origin.
Symptoms reported included mild substernal ache with occasional "difficulty taking deep breaths", light headedness, tight sensation around the throat area, and occasional "jaw ache". Patients exercises 3-5 times per week for 1-2 hours at high intensity with no symptoms.
Last 12 lead was normal although intermittent monitoring strips have shown unifocal PVC's. Patient is 38 with normal to low bp and no known other health issues.