ML is a 51 year-old Hispanic female. You have been following her for almost 2 years now and have been working very hard with her to manage her Type 2 DM, her hyperlipidemia, and her HTN. You have her DM and hyperlipidemia under control as evidenced by laboratory values. You’re still working on her HTN. Given all of her risk factors you want her B/P to be under 130/80. At this time, she is only on ACEI daily for her HTN. She presents to you today for her usual follow-up visit and upon ROS she reveals that she has been having substernal chest tightness periodically. Sometimes occurs with exertion and resolves with rest. Medications: Metformin 1gm bid Lisinopril 20 mg qd Atorvastatin 20mg hs PE: Pt is morbidly obese. Cardiac exam: PMI at 5th ICS mid-clavicular line. Regular rate and rhythm, no S3/S4, or murmur present. Lungs: clear to auscultation bilaterally without crackles, wheezing, or rhonchi present. Extremities: 1 pitting edema present to bilateral lower extremities. No wounds present. Strong pedal pulses bilaterally.What is the most likely diagnosis and why?
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