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Case 3: Acute chest pain
  1. Christopher S R Baker
  1. Charing Cross and Hammersmith Hospitals, London, UK

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A 49 year old Afro-Caribbean woman presents to A&E after a 30 minute episode of severe, burning central chest pain radiating to the throat. When she had the pain she felt cold and sweaty but is now symptom-free. Episodes of a similar but less severe pain had occurred daily for the previous 10 days, predominantly at rest but also when climbing the stairs at home.

The patient has multiple risk factors for coronary disease (including type II diabetes, hypertension, and being a smoker), but the clinical presentation is not absolutely typical for coronary artery disease and the initial ECG is normal. There is also a history from the patient of an exercise stress test one week before, which she believed to be normal.

The significance of these signs and symptoms, the diagnosis, and the short and long term treatment of these problems are discussed in an interactive case presentation.

Learning objectives

When you have completed this case you should understand:

  1. Risk assessment in patients with an acute coronary syndrome (ACS)

  2. The natural history of ACS

  3. The potential pitfalls in data interpretation

  4. Choosing who needs early intervention in ACS

  5. The best combination of drug treatment and intervention in this situation