Common things are common

A 49-YEAR-OLD GP colleague who is a fairly active cyclist starts to develop discomfort in his right shoulder with exercise that is relieved with rest.

He is a non-smoker, has normal cholesterol levels and is not diabetic. He takes amlodipine 5mg for hypertension. His father had a myocardial infarction at age 53. He has no other significant medical illness. He consults you for an opinion and asks if you can do a stress ECG as he doesn’t think its coronary disease. “It’s on the wrong side” but he “just wants to make sure”.

Physical exam is normal and his