Cardiology>>>>>Ischaemic heart disease
Question 21#

You are asked to review a 32-year-old smoker in the ED. He has presented with an hour of ongoing chest pain. The pain is described as left-sided and sharp but not focal. There is no postural change and no change with inspiration. He appears clinically well. The emergency team are concerned because he has anterior ST elevation and show you his ECG

What do you recommend?

A) Activation of the primary angioplasty team
B) Await troponin tests and give analgesia
C) Non-steroidal anti-inflammatory analgesia
D) Urgent bedside echo to rule out a regional wall motion abnormality
E) CT pulmonary angiogram

Correct Answer is D


The diagnosis is uncertain in an acute patient. Pericarditis is more likely, but the anterior ECG changes are most prominent. In the context of ongoing chest pain acute, ischaemia must be urgently ruled out. A bedside echo is the best initial test to exclude a regional wall motion abnormality.