Welcome back clinical problem solvers, the final case of chest pain week in collaboration with the Human Diagnosis Project and Hannah Abrams.

We hope you enjoy.

Hey, folks, just a quick reminder that this podcast is not meant to be used for medical advice, just good old-fashioned education.

All right, so welcome to Friday of chest pain week. Our next case is a case by Dr. Nick Duka at Penn State.

This is the case of a 26-year-old woman who's had intermittent chest pain for one month.

She describes the pain as a sharp and throbbing sensation in the center of her chest.

It happens after she drinks wine, but not after any other foods or liquids. She gets

flushing and a cough, and it resolves after 30 minutes. And this has been going on intermittently

for the past month. She's also noticed night sweats for the past two months, and she lets you know

that she has a medical history of asthma and gurd. All right. So I think as a recap from Monday's episode, you always want to start with

ensuring that the eight life-threathing causes of chest pain four plus two plus two are not at play.

And I think the one reassuring thing here is both the duration and the tempo of this disorder.

So a month-long of symptoms with episodic

features without really progression of the severity of the pain makes all those eight causes a little

bit less likely. So while we always have to be open to this imperfect test being wrong,

I think we can move away from those eighth-life-threathing causes.

And as is true when trying to establish a cardiopulmonary cause of chest pain, associating

it with exertion is often very helpful.

And here, it's very tempting to ask, what is unique about drinking wine that brings

on the chest pain specifically that other foods

do not?

And I think that it's important to recognize the sort of gastric, irritative effects of

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