My African American female patient came to the office with complaints of SOB and shoulder discomfort that radiates between her shoulder blades while she exercises and is at the peak of her exercise routine. She also stated that she felt nauseous and sweat

  

My African American female patient came to the office with complaints of SOB and shoulder discomfort that radiates between her shoulder blades while she exercises and is at the peak of her exercise routine. She also stated that she felt nauseous and sweaty. She said it started 3 days ago while she was at dance class. Once she stopped dancing, her symptoms resolved in about 3 minutes and they have not reoccurred. This patient has a BMI of 33.5, BP of 146/90. Her teeth in poor repair, gums reddened and receding, filled cavities noted.  Mild JVD in recumbent position and PMI 5th ICS displaced 4 cm laterally. Trace edema in lower extremities.

Her medical history is: Hypertension, Metabolic Syndrome, and Dyslipidemia. 

Labs: AIC 6.4%

Fasting glucose 135 mgs/dl

Total Cholesterol: 230

Triglycerides 180 mgs/dl

Ldl 180

Hdl 38

Please help me to formulate a diagnosis 

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