Cardiovascular
Case 17: Severe Chest Pain in a Man with Diabetes
CASE
A 58‐year‐old man with type 2 diabetes is at work when he experiences persistent and severe central chest pain, without any radiation. He hopes that it will go, but it doesn't, and after 1 hour calls 999. He is taken to the local hospital. In A&E, he explains that over the past few weeks he has had three or four similar episodes, each one lasting just a few minutes, none of which have been related to exercise. He does not smoke, is moderately obese, with a BMI of 35, has well treated hypertension, and had a cholesterol of 5 mmol/L about 4 months ago. Other than diabetes, there is no other relevant previous medical history. He is taking metformin, aspirin, and an angiotensin‐converting enzyme (ACE) inhibitor. Examination shows him to be obese, in pain, with some mild tenderness to palpation of the anterior chest wall. He is in sinus rhythm, heart rate 90 beats/min, blood pressure 160/85 mmHg, his jugular venous pressure is not raised, normal heart sounds, no pathological murmurs, clear chest examination. All peripheral pulses are present and undiminished. Abdominal examination was unremarkable. Oxygen saturation is 98% on air. Before the ECG is taken, the diagnosis is considered.
QUESTION 1
Your score this session: 0 of 0
Prior to him developing these symptoms, what is the pre‐test probability of coronary disease?