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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