Authors: Christopher Chung, Graham Johnson, Andrew Tabner / Editor: Steve Corry-Bass / Reviewer: Andrew Tabner, Christopher Chung / Codes: CP1, ResP1, SLO1 / Published: 13/11/2023

A 43-year-old woman presents to the emergency department (ED) with chest pain. She reports having pain in various parts of her chest/torso (under her left breast, the left posterior chest, left upper arm, lower back and hips) for a number of years. These pains have now become daily and persistent, precipitating her presentation to the ED. Initially the pain was intermittent and would occur both at rest and during exertion. She denies shortness of breath, sweatiness, clamminess or palpitations. She does not report cough, sputum, fever or weight loss.

The patient tells you that she emigrated from Sudan to the UK four years ago; her pain started a few months after her arrival in the UK.

She denies any past medical history and takes no regular medications. She is a non-smoker, doesn’t drink alcohol and has never been in employment.

On examination she is alert and appears comfortable at rest. She is overweight, of black African ethnicity and dressed in full-length sleeves and dress as well as hijab; she tells you she is a Muslim. Her chest is clear and her heart sounds normal. She has no oedema and her JVP is not elevated. There is no clinical evidence of DVT.

ECG: sinus rhythm, down going T waves V1 and V2, no evidence of ischaemia. Her troponin, d-dimer and chest X-ray are unremarkable.