Case 2

A 58-year-old woman comes to the emergency department with retrosternal chest pain that has been occurring over the past few weeks. The pain was initially related to physical activity, however, over the past few days it has been occurring while she is at rest. She presents today as the pain has been constant for the last hour and is radiating to her jaw and arms.

She is a smoker but otherwise has no past medical history of note.

An ECG is performed at triage and is shown below. Her initial troponin is normal.

Question 1

What are the two most likely diagnoses?

Question 2

What investigations will help clarify the diagnosis in ED?

Question 3

How do you manage this patient in the Emergency Department?