Case 2
A 64-year-old man presents to the ED with recurrent episodes of chest pain at rest over the preceding 12 hours. His current episode has been ongoing for 90 minutes and is described as severe, ‘tight’, retrosternal and associated with nausea and vomiting.
On examination, he is pale and clammy; his pulse is 110; BP is 90/65; SaO2 is 92% on air; respiratory rate is 20. He has normal heart sounds and some minor bilateral basal crepitations.
His pain does not fully settle with opiate analgesia but his SaO2 rises to 97% with oxygen. Further history reveals that he has had a previous myocardial infarction, that he is an ex-smoker with a positive family history for ischaemic heart disease and that he is on treatment for hypertension and hypercholesterolaemia. His medication list includes aspirin, GTN, simvastatin, atenolol and ramipril.