A woman with central chest pain
A 78 year old woman presented to her local hospital with a 90 minute history of severe chest pain, scoring 7/10 in severity, which had started at 9 am that morning. It was central, did not radiate, felt like “indigestion,” and was associated with shortness of breath. She had experienced similar, though milder, pain starting the previous afternoon during an intense argument.
She had a history of lumbar spinal stenosis but was otherwise well. She took no regular drugs and had no known allergies. In terms of cardiovascular risk factors she was a current smoker with a 60 pack-year smoking history but she denied any history of hypertension, hyperlipidaemia, diabetes, or a family history of ischaemic heart disease. She cared for her middle aged daughter with Down’s syndrome who lived with her at home.
Observations showed she was alert (Glasgow coma scale score 15/15) and afebrile (37.1°C) with a respiratory