Author: Susan Allen / Editor: Jason Kendall / Reviewer: Jon Bailey / Codes: RP4, SLO1, TP10 / Published: 12/02/2022

Whilst waiting in the Emergency Department (ED) relative’s room a 59-year-old woman complains of chest pain. Her husband has just suffered a cardiac arrest and is requiring ventilatory support. Her chest pain is severe, radiates to both arms and is associated with feeling clammy and dizzy.

This patient has no previous ischaemic heart disease (IHD), but has several risk factors for IHD: hypertension (controlled), hyperlipidaemia (treated), Diabetes Mellitus (insulin dependent), a strongly positive family history and a high BMI. She is a non-smoker.

On examination her pulse rate is 115, blood pressure is 110/70, respiratory rate is 23, and oxygen saturations on air are 94%. She has normal heart sounds and mild bilateral basal crepitations.

Her chest pain responded to sublingual GTN, increments of morphine and a nitrate infusion.

Blood glucose was 23mmol/L on admission, requiring a sliding scale insulin regime to be commenced.

Her initial ECG11 is shown below:

A working diagnosis of an acute coronary syndrome (ACS) was made and she was commenced on appropriate anti-thrombotic therapy.

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