© 2002 Canadian Medical Association or its licensors Review

An information sheet for patients appears as an appendix at the end of the article. The case Mr. K, a 57-year-old man, presents to the emergency department with sudden onset of chest pain radiating to the left arm of 30 minutes ’ duration. Ten days earlier he ex-perienced a similar episode of pain that lasted 10 minutes as well as several intermit-tent episodes of pain over the subsequent week that lasted about 5 to 10 minutes each and were not related to physical activity. His medical history includes peptic ulcer and arterial hypertension. He had an acute ischemic stroke 1 year ago, at which time a stenosis of 80 % in the left internal carotid artery was detected and treated by carotid endarterectomy. His risk factors for ischemic heart disease are hy-pertension, dyslipidemia and cigarette smoking. At presentation, his blood pressure is 190/90 mm Hg and he is given ASA, atorvastatin, enalapril, amlodipine and omeprazole. An electrocardiogram (ECG) shows ST-segment depression in the infe