Retiree with suspicious pain

Scenario

A retired school principal, aged 70, had been generally well and active for the past 10 years. He described an episode where two weeks ago, after he had been gardening, he experienced prolonged chest tightness that lasted two hours and was associated with nausea. He did not seek immediate medical attention. 

Since then he had not noticed any further chest discomfort but had been aware of shortness of breath with mild effort as well as intermittent palpitations manifest as an increased awareness of his heart beating strongly.

His CV risk factors included mild hypertension and

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