CASE 1
A 48-year-old bus driver presents with ‘pressure’ over his chest when walking long distances, worsening over the last few months. He also notes that chest pain occurs when he is angry or when out in the cold.
The pain is relieved on rest and when taking his GTN spray.
He is obese, smokes 20 cigarettes a day, drinks 30 units of alcohol a week and suffers from hypercholesterolaemia.
He has a family history of diabetes, and his mother has hypertension.
CASE 2
A 59-year-old builder with a history of sudden onset retrosternal chest pain radiating to his jaw and his left arm at rest. The pain is not relieved by GTN spray and lasts for 20 minutes.
He is also complaining of feeling nauseous, cold and breaking into a sweat. He is known to suffer from diabetes, hypertension and hypercholesterolaemia.
He is currently taking aspirin, bisoprolol, nicorandil, ramipril, ISMN, simvastatin and metformin. His brother died aged 49 from a heart attack.
Case 3
A 39-year-old gentleman who suffers from Marfan syndrome presents with sudden onset of severe tearing central chest pain which radiates to the back and is persistent in nature.
His past medical history includes hypertension.
He is a known smoker but has been teetotal for his whole life.
CASE 4
A 25-year-old pregnant lady recently returned from a long flight from Thailand complaining of right calf pain and swelling.
She has recently developed sharp onset chest pain, worse on deep inspiration and associated with slight haemoptysis and shortness of breath.
She does not complain of any pain on movement or mention any recent falls or trauma
Case 5
A 28 year old lady complaining of acute onset of retrosternal chest pain that radiates to her left shoulder. She has recently suffered with a viral infection.
The pain is made worse on deep inspiration and lying down, whilst it is relieved on sitting forward and taking ibuprofen.
She is not taking the pill. There is no relevant family history.
Case 6
A 34-year-old gentleman who works in an Indian restaurant. He complains of a burning sensation in the lower chest that radiates to his throat. The pain is worse on lying down and after meals but improves on leaning forward. He also notes a bitter taste in his mouth with extra salivation in the mornings.
He drinks 6 cups of coffee every day and is a heavy drinker.
He smokes 2 packs of cigarettes a day. He also states that he has been taking ibuprofen for a recent cold.
CASE 7
•A 32-year-old delivery man complaining of an acute onset of aching pain localized on the right chest wall. It is made worse on inspiration, movement and lifting, and is tender to touch.
There is no radiation nor any associated symptoms such as shortness of breath, palpitations or haemoptysis.
There is no relevant past medical, family or drug history. He is a social drinker.