Que - 41 year old female presented to ED with central chest pain which is 'burning and tight' feeling and around neck. No previous medical history or significant family history. Examination - Unremarkable. ECG showed minimal non specific ST depression which resolved in repeat ECG in 30 min. CBE, MBA20 (EUC + LFT) and troponin T - negative. What is your next step?
Ans -
1 - Discharge patient without any intervention
2 - Discharge patient with pantoprazole and GP follow up for endoscopy
3 - Admit patient for serial cardiac enzymes
4 - Admit patient for endoscopy
5 - Arrange urgent primary coronary intervention
Ans -
1 - Discharge patient without any intervention
2 - Discharge patient with pantoprazole and GP follow up for endoscopy
3 - Admit patient for serial cardiac enzymes
4 - Admit patient for endoscopy
5 - Arrange urgent primary coronary intervention
The correct answer is 3. Any chest pain is MI/PE unless proven otherwise. Here pain doesn't describe as pleuritic and there is no option for PE investigation, so exclude MI and then think about other things.
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