Table 1 21 Scenarios in the analysis

Irritable bowel syndrome

Wolff-Parkinson-White syndrome

Benign prostatic hyperplasia

Vasovagal reflex

Diabetes mellitus

Transient ischemic attack

Chronic renal failure

Arteriosclerosis obliterans

Pulmonary hypertension

Pulmonary thromboembolism

Variant angina pectoris

Subarachnoid hemorrhage

Cholelithiasis

Anisakiasis

Iron deficiency anemia

Benign paroxysmal positional vertigo

Acute pyelonephritis

Acute cholangitis

Hyperthyroidism

Example scenarios

He had been experiencing intermittent epigastric pain (pain in the groin) for several days, which abated spontaneously. Today, the patient came to our hospital because his had been treated for angina pectoris 5 years ago, and sublingual nitroglycerin had not relieved her symptoms. He began to have pain in the area of his solar plexus, felt chilly, and then suddenly became feverish. At the time of consultation, his had a fever of 38.8 degrees Celsius.

He had undergone coronary angioplasty (catheterization to widen a narrowed coronary artery with a balloon) for exertional angina pectoris 5 years ago.

Medications: aspirin, Plavix, Norvasc, Renivace, Lipitor.

Life history: no smoking, no alcohol consumption, nothing else of note.

Since the patient has a history of angina pectoris in the past, it is naturally tempting to consider a recurrent attack of angina pectoris, but the key point is whether other diseases can be considered there as well. In particular, since there is no fever with angina pectoris, can we consider infection?

The first complaint, “What happened to you today?” In response to the first complaint…”

“I have a pain in my solar plexus.”

If you are asked to elaborate a little more…

(1) I had a pain in the area of my solar plexus several times a day for a few days, but it had gotten better without any treatment.

I have had catheter treatment for angina in the past, so I thought it might be angina again and tried sublingual nitroglycerin, but it didn’t work at all.