Torn between two pains

Author: Eduard Deda / Editor: Nick Tilbury / Codes: / Published: 24/02/2022

A 57-year-old gentleman self-presents to the Emergency Department (ED) with a 1-hour history of a posterior headache and chest pain.

The headache started suddenly while he was sitting down at his desk, and he says it came on like a slap to the back of the head. He rates it as 5/10 in severity.

He also tells you he developed central chest pain around the same time as the headache and describes it as a tightness across his chest. It is non-radiating, there are no exacerbating factors and there is no relief from simple analgesia.

The patient has known hypercholesterolaemia and hypertension, for which he takes medication, but nil else of note. He has no allergies.

His observations are as follows:

  • Blood pressure 147/89mmHg
  • Heart rate 87
  • SpO2 98% on room air
  • Apyrexial

Full neurological and cardiovascular examination is unremarkable, apart from a difference in timing of the pulses of the left and right posterior tibialis.

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