Epigastric pain after meals occurs in the absence of physical or laboratory abnormalities in a 66-year-old woman slated for surgery.
A 66-year-old woman is referred to you for clearance to undergo hernia surgery. In the office, during her review of systems, she mentions that she occasionally gets 5 to 10 minutes of epigastric pain after meals, which is always relieved by taking Pepto-Bismol. She denies any chest pain, trouble breathing, or other symptoms during these episodes, and she currently has no pain. She thinks the last time she had it was 3 or 4 days ago.
The patient’s physical examination is essentially unremarkable except for mild obesity. Specifically, her vital signs are all normal, her lungs are clear, and her heart is regular, without any abnormal heart sounds. She has no abdominal tenderness or mass. Her legs are free of edema.
Below are the precordial lead tracings of her electrocardiogram (ECG) taken while she is pain-free in your office. You have no old ECG available for comparison. Labs, including a complete blood cell count, metabolic panel, and cardiac enzymes, are all normal, except for a glucose level of 132 mg/dL.
Can this patient be cleared for surgery or should she have a stress test first?
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