Speakers:
Jennifer Hao, MD
Marc Larochelle, MD, MPH
Ayelet Shapira-Daniels, MD
Kimberly Mak, MD, MPH

Learning Objectives:

1. Apply a structured framework to evaluate subacute chest pain in clinic and identify features that require ED referral.
2. Review the patient’s EKG to detect subtle “can’t miss” findings, including ischemia, STEMI equivalents, and alternative high-risk causes.
3. Incorporate prior oncologic treatments, such as anthracyclines or chest radiation, into risk assessment and adjust the threshold for further testing or referral.
4. Define mantle field radiation and contrast historical vs modern radiation techniques, emphasizing how older radiation treatments are higher-risk for future complications. 
5. Review common cardiovascular sequelae of mediastinal radiation, including coronary artery disease, valvular disease, pericardial disease, and conduction abnormalities, etc. 
6. Apply these risks to the current case by highlighting the patient’s existing radiation-related complications, and explaining why her chest pain representing a high-risk presentation than the average female patient her age.