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An 88-year-old woman presented to our hospital due to an 18-hour history of worsening central chest pain. She had a dual-chamber pacemaker due to second-degree Mobitz type II atrioventricular block implanted 10 years ago. Her risk factors included hypertension and hypercholesterolaemia. Her

A previously healthy 25-year-old woman in her 29th week of pregnancy arrived to the emergency department due to fever up to 39°C for the previous 5 days. Additional symptoms included central chest pain with coughing and deep inspiration, odynophagia, dry cough and dyspnoea at rest. On initial

A 23-year-old female presented with 3 months of central chest pain and fever. Clinico-radiological investigations were consistent with an anterior mediastinal mass. This clinicopathologic conference discusses the differential diagnoses of such a presentation and their management options.

KEY POINTS A 40-year-old Indigenous Australian woman was airlifted to hospital from a remote community. She had central chest pain, dyspnea, pedal edema and diabetic ketoacidosis, which she had developed after she stopped taking insulin because of her chest pain. Anxious to remain in her community

A 32-year-old man presented with palpitations and central chest pain, examination was unremarkable and chest radiograph was normal. ECG demonstrated right axis deviation and inferolateral T-wave inversion; cardiac enzymes were normal. Cardiac MRI demonstrated multifocal, patchy subepicardial and mesocardial left ventricular late gadolinium enhancement, suggestive of cardiac sarcoidosis. Whole body and dedicated cardiac fluorodeoxyglucose (FDG)-positron emission tomography (PET) was performed 60 min after radiotracer injection following a special patient preparation to suppress physiological myocardial uptake of glucose. This consists of a high-fat, low-carbohydrate diet the day before scanning followed by a 15 hours fast. The PET revealed multifocal metabolically active cardiac inflammation, corresponding to the areas of late gadolinium enhancement on MRI and extensive sites …

A 69-year-old chef presented to the emergency department with sudden onset shortness of breath, central chest pain and haemoptysis. His medical history included hypertension, type 2 diabetes mellitus, left total hip replacement and an anterior ST elevation myocardial infarction which required rescue

Phlegmonous esophagogastritis is an extremely rare condition characterized by diffuse inflammation of the upper gastrointestinal tract, sparing the mucosa. Patients can present with an acute onset of symptoms, and computed tomography scans can show diffusely edematous wall with intramural low attenuation surrounded by ring enhancement. Here we report such a case of a man who presented with central chest pain and breathing difficulty. The patient developed respiratory distress due to compression of trachea by the edematous esophagus.

47-year-old man presented to the emergency department with anterior central chest pain. He fell from his bicycle a few hours ago and had hit his chest against the handlebar. Physical examination revealed tenderness, swelling and bruising over the central sternum. Bedside ultrasonography of the sternum was performed using Sonosite S-FAST machine with a high-frequency (13-6 MHz) linear probe

Patient Initials or Identifier Number Mr. S.U.N, 69 years Male ### Relevant Clinical History and Physical Exam Mr. S U N, 69 yrs old Bangladeshi retired gentleman admitted with the history of severe central chest pain for 1 hour along with Tachycardia and sweating. He also has Thready Pulse

A 63-year-old man presented to the emergency department with a four-hour history of severe central chest pain. He had a history of smoking, hypertension and diabetes mellitus; a single-chamber pacemaker had been implanted for third-degree heart block four years earlier. The baseline

Patient initials or identifier number MR P ### Relevant clinical history and physical exam A 57 years-old, smoker with underlying diabetes mellitus, hypertension, dyslipidemia, was presented with one episode of generalized central chest pain and discomfort. It was not associated with nausea

Patient initials or identifier number Mr. X ### Relevant clinical history and physical exam A 54-year-old nondiabetic, normotensive, dyslipidemic with positive family history for IHD was admitted in an emergency with the complaints of severe central chest pain for last 6 hours. ECG showed

A 17 year old girl visited several physicians with the complaints of upper central chest pain for eight months. She was finally diagnosed as upper thoracic (third thoracic vertebra) tuberculous spondylitis. The diagnosis was probably delayed for its unusual site of presentation and delayed onset of constitutional features like fever, anorexia and weight loss.

With the introduction of the coronary care units (CCU) the question of an early diagnosis of acute myocardial infarction (AMI) has become of great importance. The main criterion for admission to these units has been central chest pain. In this study the localization and radiation of chest pain has been analysed. No typical localization of the chest pain has been found in the patients with AMI compared to those admitted to the CCU but found not to have AMI. The radiation of pain to the neck and arms is, however, highly significantly more common in patients with AMI than in the controls.

Patient initials or identifier number DM ### Relevant clinical history and physical exam A gentleman in his mid-60s was referred directly to the cardiology cath labs with a 2 hour history of sudden onset severe central chest pain. His main risk factor was a positive smoking history.

A 65-year-old man presented to the emergency department. He reported experiencing a 20-min episode of central chest pain with an aching character and no radiation. He had no significant past medical history. Serial electrocardiograms showed no ST segment or T-wave abnormalities. High-sensitivity cardiac troponin T (hs-cTnT)4 concentrations (Roche Elecsys, 99th percentile 14 ng/L, CV

The life-threatening experience of an acute myocardial infarction stimulates a wide variety of physical and psychological responses for both the person and his family. The nurse's role is to assist a person through a major life crisis from a dependent to an independent status. The Roper, Logan and Tierney model for nursing provides a suitable framework for nursing a person who has suffered a myocardial infarction. This approach to care ensures that maximum health potential is achieved.

A 72-year-old woman presented with severe central chest pain and a loud continuous murmur. Blood pressure was 105/70 mmHg. She had undergone elective aortic valve and root replacement 7 years previously. Her coronary angiogram was normal. Three years later, a patent ductus arteriosus (PDA) which had been missed was successfully closed percutaneously using …

A 59-year-old builder presented to the accident and emergency department with a 4-week history of intermittent central chest pain. He was a lifelong non-smoker, had no asbestos or tuberculosis exposures, and had no cardiac risk factors. The …

My 13 year old son Tom was known to have congenital valvular heart disease affecting all of his valves. The severity of the valve disease was classified by the consultant paediatric cardiologist he saw regularly as relatively mild. At his last review, 15 months before he died, we gave a cardiologist a history of central chest pain on extremes of exertion or cold. There were four or five particularly memorable episodes. One was climbing a mountain, when the pain subsided promptly with rest. Another was in a cold swimming pool, and the pain subsided within minutes of warming …

A 71-year-old man was referred to a rapid access chest pain clinic by his general practitioner. He presented with a 6-month history of twice weekly central chest pain lasting 2-3 min with walking and exertion, relieved with rest or co-codamol tablets. After initial investigations and a positive myoview scan, he was listed for an elective coronary angiogram. Unfortunately, the procedure was abandoned due to unclear course of the guide wire and a possible aberrant aortic course. Further non-invasive tests were arranged to clarify the anatomy of the vessels. After getting a clear idea of the aberrancies, coronary angiogram was replanned, and the patient underwent successful angiography with angioplasty to one of the coronary arteries, without any complications.

Report by Richard Body, Clinical Research Fellow Search checked by Craig Ferguson, Clinical Research Fellow Manchester Royal Infirmary, Manchester, UK In [patients with chest pain of suspected cardiac origin] does [measurement of serum PAPP-A [pregnancy-associated plasma protein A] on admission] allow [exclusion of acute coronary syndromes]? A 45-year-old abusive, intoxicated recurrent attender complains of central chest pain of 2 h duration. His initial electrocardiogram is normal. Your gut feeling is that he does not have an acute coronary syndrome. You are reluctant to admit him for troponin estimation at 12 h, but wonder if you ought to risk discharge without further investigation. Having heard about PAPP-A, a promising cardiac marker, you wonder if the evidence is sufficient to allow it to …

A 42-year-old man was admitted with central chest pain which he described as “someone sitting on his chest”. He had a strong family history of premature coronary artery disease and raised cholesterol. He completed over nine minutes of …

A 54 year old woman presented with intermittent dull central chest pain, which occurred at rest and was not exacerbated by exertion. She also complained of shortness of breath and reduction of her exercise tolerance to a few yards only over the previous four weeks. She smoked 15 cigarettes per day and …

Figure 1 illustrates the electrocardiogram (ECG) of a 42-year-old man who presented with sharp central chest pain that initially worsened with inspiration but did not appear to vary with his position. Describe the key features of the ECG and the differential diagnosis.

A 54 year old woman was admitted with a history of central chest pain. She was a smoker and had a family history of ischaemic …

This patient presented with severe central chest pain and the electrocardiogram (ECG) in Figure 1. What are the principal findings and which specific diagnoses should be promptly evaluated?

Pulmonary embolism is the third most common cause of death in the United States. It accounts for up to 100,000 deaths annually, and approximately 33% of the deaths occur within one hour of the onset of symptoms. This chapter explains the effects of pulmonary emboli on gas exchange that is multifold. Hemodynamic effects of pulmonary emboli depend not only on the size of embolus, but also on the patient's baseline cardiopulmonary status. The chapter explores the diagnosis of pulmonary embolism that should be strongly considered in patients who manifest one or more of the following clinical patterns: central chest pain, acute unexplained dyspnea, pulmonary infarction, and acute cor pulmonale and cardiogenic shock.

A 71-year-old man complained of central chest pain radiating to his back and neck and both arms. Investigations for ischemic heart disease were negative. Chest x-ray showed a soft tissue density in the aortopulmonary area. CT scan revealed a saccular aneurysm arising from the inferolateral aspect of the mid-transverse arch of the aorta, measuring a maximum diameter of 7 cm (Figure 1). The presence of fluid in …

A 49 year old Afro-Caribbean woman presents to A&E after a 30 minute episode of severe, burning central chest pain radiating to the throat. When she had the pain she felt cold and sweaty but is now symptom-free. Episodes …

Recurrent central chest pain is a common clinical problem. Not surprisingly, most patients will want to know if the symptom arises from the heart and, if so, whether they are at risk of a sudden cardiac event. In general practice in the UK more than half such patients turn out not to have cardiac disease 1 , while about 10% of the more highly selected group who end up having diagnostic coronary angiography have no abnormality of the epicardial arteries. These patients have a low mortality, but up to 75% suffer persistent symptoms and a poor quality of life over long follow-up periods (2‐ 10 years) and 30‐ 50% of them never return to work and are unable to carry out household tasks. Many remain convinced that they have a cardiac disorder, even if an alternative diagnosis has been proposed, continuing to take cardiac medications and to use medical resources 1‐3 .

Answers on p xxx. Answers on p 612 . A 76 year old women presented to casualty with a three hour history of central chest pain radiating to the back and left arm. She was dyspnoeic …

A 79-year-old woman presented to the accident and emergency department with a short history of central chest pain radiating to the arm and epigastrum, associated with vomiting. There was no history of haematemesis and no recent change of bowel habit or melaena. She had a myocardial infarction 4 months previously and had a metal prosthetic mitral valve replacement for which she was anticoagulated with warfarin, maintaining an INR between 2.5– 3.5. On examination she appeared pale, but there were no other abnormal findings; the liver was not enlarged or tender.

Central chest pain, particularly if precipitated by exertion, implies the likelihood of coronary artery disease to both patient and physician. William Heberden, who introduced the term “angina pectoris” with a full and accurate account of the condition in 1772, failed himself to connect angina with the heart1. Originally, angina was a descriptive term derived from the Greek word ανχηoνe for an inflammatory neck condition2 to convey a sense of the strangling quality of the symptom. With the recognition of coronary artery disease in this century, angina pectoris and heart disease have become synonymous, to the extent that one eminent cardiologist has suggested that angina “is, by definition, associated with a disturbance of myocardial function”3. However, the possibility that oesophageal disease might give rise to similar symptoms was apparent even in Heberden’s description of angina, as he observed that the symptom could occur during swallowing or after a meal. Indeed, he speculated (perhaps prophetically when seen from the viewpoint of a gastroenterologist) that the source of angina “may be a strong cramp, or an ulcer, or both”1.

Case history A 78-year-old woman with a past medical history of systemic hypertension and cigarette smoking was admitted to the emergency department with severe central chest pain radiating to her back. General physical examination was unremarkable other than revealing pronounced hypertension. Her blood pressure in the right arm was 176/116 mm Hg and in the left arm was 185/105 mm Hg. A 12 …

A 55-year-old man, with a history of hypertension and smoking, presented with severe acute onset central chest pain, radiating through to the back and down to the …

A 56 year old male smoker with a one year history of hypertension presented with a two hour history of severe, tight, central chest pain. Examination revealed that he was sweating profusely and had cold peripheries. His blood pressure was 90/60 mm Hg and auscultation of the chest revealed evidence …

Report by Steve Jones, Clinical Research Fellow Search checked by Ian Crawford, Clinical Research Fellow A 45 year old man is brought to the emergency department with acute, central chest pain. You have diagnosed an acute myocardial infarction from the ECG for which he is receiving …

Acute pericarditis is characterized by central chest pain, pericardial friction rub, and electrocardiographic abnormalities typically evolving in four stages. However, as many as half of the patien...

Two hundred and ninety-six patients were admitted to geriatric medical beds in Cardiff in 1976 with acute central chest pain. One hundred and eighty-six (63 per cent) had a confirmed acute myocardial infarction. Of the 37 per cent without evidence of cardiac infarction, 32 per cent were on beta-blocking drugs. The possible role of adrenergic blocking agents in producing acute central chest pain is discussed.

A 40-year-old man with Björk-Shiley valves implanted in the aortic and mitral positions nine months previously presented with central chest pain. Shortly after admission he developed clinical features consistent with left ventricular failure. Fracture of the mitral prosthesis was diagnosed by echocardiography. At emergency operation the outlet strut of the mitral valve was found to be fractured and the disc was in the left ventricle. The patient survived valve re-placement and is in good health four years later.