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

Last week we presented the case of Peter Hartl, a heavy smoker with a history of hypertension, who went to his local emergency department complaining of severe chest pain. His electrocardiograph suggested myocardial ischaemia. We invited responses on bmj.com about the differential diagnosis, further investigations, and how to respond to his wife's concern. To look at the rapid responses and discussion of the case so far go to bmj.com (BMJ 2003;326:920)

Chest radiograph …