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Rc of retrosternal chest pain which sounds ischaemic cardiac in nature.
He has a previous history of myocardial infarction and he states that this pain is similar in character but perhaps not quite as severe.
In addition to ischaemic heart disease he has hypertension, hypercholesterolaemia and is taking aspirin, simvastatin, ramipril and atenolol.
His pain has settled with some morphine and GTN and there is nothing specific to find on examination.
A 65-year-old man presents to the ED with a two hour history of retrosternal chest pain at rest which sounds ischaemic cardiac in nature. He has a previous history of myocardial infarction and he states that this pain is similar in character but perhaps not quite as severe. In addition to ischaemic heart disease he has hypertension, hypercholesterolaemia and is taking aspirin, simvastatin, ramipril and atenolol. His pain has settled with some morphine and GTN and there is nothing specific to find on examination.
Which of the following are in the clinical differential diagnosis at this stage? Choose as many as you think appropriate.
The patient’s 12 lead ECG shows ST segment depression in leads V1-V3. What could be ruled out of the differential diagnosis now?
Additional leads (posterior and right sided) reveal no ST segment elevation. What is the differential diagnosis now?
What further investigation is required to establish a firm single diagnosis?
