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A 70-year-old man was referred to a cardiologist for evaluation of exertional chest pain and dyspnea. The first thing that comes to mind in a man in this age group with exertional chest pain and dyspnea is the possibility of myocardial ischemia, most probably due to coronary artery disease. The combination of exertional chest pain and dyspnea is an interesting one. Chest pain with effort is frequently angina; what about the dyspnea? Dyspnea can be one of the manifestations of myocardial ischemia, secondary to an increase in left ventricular diastolic pressure and therefore elevation of the pulmonary venous pressure. In… © 1992, Massachusetts Medical Society. All rights reserved.