Case 3

A 77-year-old man presents to the emergency department with three hours of retrosternal chest pain. It is severe, ‘tight’, radiates to both shoulders and is associated with breathlessness, sweating and nausea. He reports that he has had a previous MI. He is not known to have any pre-existing ECG changes. He is pale and clammy. In addition:

  • Pulse is 80
  • BP 105/80
  • Respiratory rate is 22
  • SaO2 is 94% on 15L O2
  • On auscultation you hear a third heart sound and bilateral basal crepitations