Value of non-invasive imaging in acute chest pain

Abstract

A 76-year-old lady without prior cardiac history, presented to the hospital with sudden onset, retrosternal chest pain. Her symptoms started while rushing to post office near closing time. She was annoyed as she forgot to bring the letter with her. Her symptoms started when she returned to her car and had an argument with her husband. She was a lifelong non-smoker. She had no history of chest pain and angina. She had no significant past medical history of note. On admission, she was afebrile, normotensive (110/70 mmHg) and slightly tachycardic (110 bpm regular). Clinical examination revealed no signs of heart failure and no other abnormality. Initial laboratory investigation included Haemoglobin 13.1 g/dl (normal range (NR) 11.5–16.5 g/dl), leucocyte count 8.1 × 109/l (NR 4.0–10.0 × 109/l), Na+ 142 mmol/l (NR 135–145 mmol/l), K+ 4.3 mmol/l (NR 3.5–5.0 mmol/l), C-reactive protein 2.6 mg/l (NR 1.0–10.0 mg/l), Mg2+ 0.90 mmol/l (NR 0.75–1.15 mmol/l), Ca2+ 2.29 mmol/l (NR 2.10–2.60 mmol/l). Cardiac troponin-T was raised 12 h after onset of chest pain at 1.6 µg/l …