A 55-year-old smoker complains of chest pain and gestures with a closed fist over her sternum. Which of the following diagnoses should you consider because of her gesture?

The gesture of placing a closed fist over the sternum typically indicates a concern related to the heart and is strongly associated with conditions involving ischemic heart pain, such as angina pectoris. This type of pain is often described by patients as a feeling of pressure, tightness, or squeezing in the chest, which aligns with the gesture made by the patient.

In the context of a 55-year-old smoker, who is already at a higher risk for cardiovascular issues, angina pectoris is a credible consideration as it can manifest due to insufficient blood flow to the heart muscle, especially during times of increased demand. The presentation of chest pain along with the specific gesture draws attention to the type of pain often associated with cardiac conditions.

While other options like bronchitis, costochondritis, and pericarditis could also cause chest discomfort, they do not typically elicit the same kind of hand-over-sternum gesture that is emblematic of the pressure-like sensation associated with angina. Bronchitis primarily involves respiratory symptoms, costochondritis presents more as a localized pain that can be reproduced with palpation, and pericarditis often includes sharp pain that may improve with sitting forward, which does not align with the closed fist