Case 1

A 66-year-old woman presents to the emergency department (ED) at 8 am with a 2-hour history of chest pain; it is retrosternal and radiates to both shoulders. She had a previous episode which occurred just prior to going to bed at about 11 pm the previous evening.

She is known to be hypertensive but is otherwise well. She is on a beta blocker and an aspirin. She has had no previous episodes of chest pain. She has had a pregnancy-related pulmonary embolism in the past. She has a positive family history for ischaemic heart disease.

On examination her pulse is 60 per minute, her respiratory rate is 18 per minute, O2 saturations 96% on air, BP 115/65, heart sounds are normal and her chest is clear.

Her ECG is as shown (Fig 1)