A 14-year old female is brought to you by EMS from school. She complains that she had mid-sternal chest pain that radiated to the neck. It lasted about 45 minutes and resolved spontaneously. She had nausea during the event but did not vomit. She had no shortness of breath, but did feel anxious and that her heart was beating fast. The school nurse called EMS. The EMS personnel think that she is just having a case of "the nerves."

She has no past medical problems.

She takes no medications, has no allergies, and denies any tobacco or drug use.

Appearance:	VS Temp 37.8C, HR 82, RR 14, BP 98/52, Wt 58Kg. She appears well and has no symptoms at this time.
HEENT:	NCAT, supple neck, no JVD or bruits, clear throat, no adenopathy
Lungs:	clear bilaterally
Heart:	S1, S2, RRR no murmurs, rubs, or gallops
Abdomen:	Benign
Extremities:	2+ pulses x 4, good cap refill
Neuro:	Alert and oriented, nonfocal cranial nerves, no motor or sensory deficits, normal cerebellar function