000 – The woman with chest pain

Mrs. J is a 49-year-old woman who comes into A&E in the morning complaining of chest pain. You ask her about the pain, remembering the system your mentor SOCRATES taught you. She describes the pain sitting centrally as a dull, tight ache, that came about around 2:00 am the same day. She can feel it between her shoulder blades. She feels nauseous and was a bit clammy before. The pain is intermittent, it gets better when she takes a rest, and she is a bit short of breath.

You enquire about her past medical history, and Mrs. J tells you she is anaemic and has pre-hypertension

Her father very recently passed away due to a myocardial infarction. Her sister and father both have Type 2 diabetes.

She does not smoke or drink.


What do you do next?

1) Take an ABG and D-Dimer

2) Do an ECG and measure Troponin

3) Chest X-Ray