Beat the Leak

Author: Megan Burton, Faisal Faruqi / Editor: Steve Corry-Bass / Codes: CC7, CP1, SLO3 / Published: 24/08/2020

A 45-year-old man presents to the emergency department with central chest pain since yesterday morning. The pain is described as a burning/cramping pain, eased slightly by Gaviscon. It started suddenly whilst in his car with radiation to his jaw, neck and down both arms, with a severity of 7/10. It was associated with breathlessness. Later in the day the pain got much worse – 10/10 severity whilst the patient was showering, he became dizzy and lowered himself to the floor. There was no loss of consciousness. 

Family history of note: both father and grandfather died of Myocardial Infarctions, aged 65 and 40s. 

On examination, he appears in pain but all observations are within normal ranges. His chest sounds clear, RR 20, sats 98%, no obvious murmur heard, no radial-radial delay. His abdomen is soft but tender on deep palpation in his epigastric region. 

Bloods results: FBC, Renal profile, Liver profile, Trop, Lipase are all normal

ECG shows a right bundle branch block. 

Chest XR is shown below