Case 3

A 70-year-old woman presents to the emergency department after three episodes of left-sided aching chest pain. She has osteoarthritis and has had a previous hysterectomy, but no history of smoking, diabetes, hypertension, hypercholesterolaemia or family history of coronary heart disease. There are no obvious precipitating or relieving factors, and no associated features.

Does this patient have any risk factors for coronary heart disease?

When pressed firmly, there is some tenderness over the left anterior chest wall. Does this reduce the probability of a diagnosis of acute coronary syndrome?

After a more detailed history is taken regarding the nature of her pain, she is considered to have 'atypical' angina; as stated, other than her age, she has no specific risk factors for coronary artery disease and her ECG is normal. She is discharged home with no further follow-up.

Is this acceptable?