Abstract
A 48-year-old housewife presented to hospital with acute central chest pain associated with dyspnoea at rest. The chest pain had awoken her from sleep 6 h previously, was non-pleuritic and radiated to her back. She had no past history of chest discomfort or angina however, she had been ‘worrying’ recently about a daughter who was ill. Of particular note was a background of anxiety and depression, for which she was prescribed venlafaxine. She was a lifelong non-smoker. On admission, she was afebrile, normotensive (132/78 mmHg) and had a regular pulse (110 b.p.m.). Clinical examination revealed no abnormality. Initial laboratory investigations included Hb 13.4 g/dl [normal range (NR) 11.5–16.5 g/dl], leucocyte count 7.9 × 109/l (NR 4.0–10.0 × 109/l), Na+ 144 mmol/l (NR 135–145 mmol/l), K+ 4.4 …
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