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Cardiac Chest Pain

A 49 year old male patient attends ED with chest pain. He describes it as an intermittent pressure, which lasted for 20 minutes this morning after walking home from the corner shop. This occurred two hours ago. It felt like a pressure, and was in the middle of the chest. It did not radiate. He felt slightly breathless at the time, but experienced no sweating, palpitations, or nausea. It was not altered by breathing or movement. He denies calf pain or swelling. He was treated for a chest infection two weeks ago with antibiotics from an Urgent Care Centre whilst visiting relatives in Cornwall, where he travelled to and from by coach. He is currently pain free.

his past medical history includes hypertension, and he takes amlodipine 5mg once a day. His brother had a heart attack aged 51, and his father has had angina for as long as he can remember.

He is an ex-smoker for ten years, drinks no alcohol, and works as a stock broker. he tries to go to the gym once a week.

On examination, he looks comfortable at rest.

RR 16, Sp02 98% on RA, HR 77, BP 152/90, T 36.8, GCS 15/15 BM 4.2

Cardiovascular and respiratory examination are completely normal.

His ECG shows:

Cardiac Chest Pain