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Richard A. Parker, MD; Erin E. Hartman, MS
From the Division of General Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, LY318, Boston, MA 02215.

JAMA. 1999;281:744.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In January 1998, at Medicine Grand Rounds, Lee Goldman, MD, discussed Mrs H, a 75-year-old woman weighing the risks and benefits of proceeding with an elective repair of an abdominal aortic aneurysm.¹ She had survived an emergency repair of a thoracic aneurysm and was troubled mostly by chronic dyspnea secondary to her severe chronic obstructive pulmonary disease.

Cardiac evaluation prior to her aneurysm resection showed no evidence of ischemic heart disease. However, in the past several months, she developed chest pain and was admitted to the hospital. Although cardiac enzyme levels were normal, her electrocardiogram and echocardiogram results reflected anterior myocardial infarction. Given her age and comorbidities, Dr Goldman had suggested a watchful waiting strategy, including serial measurement of the aneurysm size.

MRS H, THE PATIENT

My main problem is that I am still short of breath. I have chest pains every day and they go . . . [Full Text of this Article]