Kyra smith, who is 58 years old and postmenopausal, is seen at the women's health clinic for a routine checkup. she reports no health problems other than fatigue, some vaginal bleeding, and occasional "heartburn." the nurse's assessment identifies that kyra is at high risk for coronary artery disease (cad), and the healthcare provider (hcp) schedules kyra for screening lab work.

First, the patient is already 58 years old which predisposes the patient to developing metabolic syndrome (hyperglycemia, obesity, hyperlipidemia, etc.). The patient might be obese and with symptoms of easy fatigability and an alleged heartburn (that can possibly be cardiovascular symptoms congruent with a myocardial infarction), then a probable coronary artery disease is considered. 

Laboratory work-up for a suspected coronary artery disease is (1) a 12-L ECG to determine if there is an infarction (non-specific ECG changes or ST segment elevations), and (2) Troponin I, a cardiac biomarker for necrosis. If ECG results are normal then the patient is subjected to a stress test wherein the patient is undergoing an ECG while running on a treadmill to increase myocardial workload and trigger ischemia, if any.