Interactive case report: A 42 year old man with acute chest pain: case progression

doi:10.1136/bmj.326.7396.974

BMJ 2003;326:974 ( 3 May )

Clinical review

Interactive case report

A 42 year old man with acute chest pain: case progression

G Sodeck, registrar ^a, B Partik, consultant ^b, H Domanovits, consultant ^a.

^a Department of Emergency Medicine, Vienna General Hospital, Währinger Gürtel 18-20, A-1093 Vienna, Austria, ^b Department of Radiology, Vienna General Hospital

Correspondence to: H Domanovits hans.domanovits@akh-wien.ac.at
The first 150 words of the full text of this article appear below.

Last week we presented the case of Peter Hartl, a heavy smoker with a history of hypertension, who went to his local emergencydepartment complaining of severe chest pain. His electrocardiographsuggested myocardial ischaemia. We invited responses on bmj.comabout the differential diagnosis, further investigations, andhow to respond to his wife's concern. To look at the rapid responsesand discussion of the case so far go to bmj.com (BMJ 2003;326:920)[Free Full Text]

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Because he had severe symptoms and inconclusive electrocardiographic findings, he had transthoracic echocardiographic ultrasonographyto confirm acute myocardial ischaemia. Motion of the ventricularwall was normal, but he had mild aortic valve insufficiency andsevere left ventricular concentric hypertrophy (interventricularseptal thickness 14 mm). His global left ventricular functionwas normal, and there was no pericardial effusion. As there wereno echocardiographic signs of cardiac ischaemia, he was not givensystemic thrombolytic drugs.

Questions
1 What would you do next and why?

2 What issues does this case raise for cardiovascular risk management in primary care?

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Results from the blood tests taken . . . [Full text of this article]

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