A 42 year old man with acute chest pain

doi:10.1136/bmj.326.7395.920

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G Sodeck, registrara,
B Partik, consultantb,
H Domanovits, consultant (hans.domanovits@akh-wien.ac.at)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

Peter Hartl is a 42 year old man who enjoys working as an information technology specialist. He recently presented to his local emergency department with retrosternal chest pain. Two nights earlier, he had experienced similar symptoms associated with epigastric pain. On the advice of his wife, a nurse, he started self treatment with a proton pump inhibitor and sucralfate. The remedies had little effect, and during the next two days he experienced recurrent …