Prescribe a GTN spray to be used should the pain recur, administer
life-style advice [particularly re stopping smoking].Send blood to check her
lipid profile assuming it hadn't previously been checked [results to GP].
Refer back to GP with advice to arrange Cardiology follow-up + or - stress
test.
Bill Bailey
A&E Chesterfield
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Rowley Cottingham
Sent: Thursday, June 14, 2001 11:25 PM
To: [log in to unmask]
Subject: Chest pain
A 63 year old woman attends you at the Emergency Unit. She gives a good
history of tight chest pain. This came on while she was out for a walk, and
when she
stopped because of the pain it settled about 10 minutes later. It is now an
hour later. You ascertain that she has smoked 20 cigarettes a day for 30
years and that
she had a cholecystectomy 15 years ago. She was previously well, and feels
quite well now. She has never had chest pain before, either on exercise or
at rest.
Examination reveals a quiet midsystolic murmur without click, a blood
pressure of 153/88 and pulse of 78. Her ECG is unremarkable. In particular,
there is no ST
segment elevation nor t-wave inversion. She has a few scattered wheezes at
both bases. Her biochemical profile is normal: in particular her troponin-I
is 0.1, her
CK is 56 and the lab have not performed a CK-MB.
You make a diagnosis of a angina pectoris. What is your management now?
Best wishes,
Rowley Cottingham
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