CASE 47: CHEST PAIN
History
A 64-year-old woman has a 10-year history of retrosternal pain. The pain is often present
in bed at night and may be precipitated by bending down. Occasionally, the pain comes
on after eating and on some occasions it appears to have been precipitated by exercise.
The pain has been described as having a burning and a tight quality to it. The pain is not
otherwise exacerbated by respiratory movements or position.
Her husband has angina and on one occasion she took one of his glyceryl trinitrate tablets.
She thinks that this probably helped her pain since it seemed to go off a little faster than
usual. She has also bought some indigestion tablets from a local pharmacy and thinks that
these probably helped also.
Examination
She is 1.62 m (5 ft 4 in) tall and weighs 82 kg, giving her a body mass index of 31.3 (rec-
ommended range 20–25) There are no abnormalities to find in the cardiovascular,
respiratory or gastrointestinal systems.
- Her chest X-ray is normal and the electrocardiogram is shown in Fig. 47.1.
- She had an exercise electrocardiogram (ECG) performed and she was able to perform
8-min exercise. Her heart rate went up to 130/min with no change in the ST segments
on the ECG and normal heart and blood-pressure responses. - The haemoglobin, renal and liver function are normal.
INVESTIGATIONS
IIIIIaVLaVFaVR V1V2V3V4V5V6Figure 47.1Electrocardiogram.
Questions
- What is the likely diagnosis?
- What would be appropriate management?