A 34-year-old male accountant comes to the emergency department with acute chest pain. There is a previous history of occasional stabbing chest pain for 2 years. The current pain started 4h back at 8 pm and has been persistent since then. It is central in position, with some radiation to both sides of the chest. It is not associated with shortness of breath or palpitations. The pain is relieved by sitting up and leaning forward.
Two paracetamol tablets taken earlier at 9 pm did not make any difference to the pain. The previous chest pain had been occasional, lasting a second or two at a time and with no particular precipitating factors. It has usually been on the left side of the chest, although the position had varied. Two weeks back he had an upper respiratory tract infection lasting 4 days consisting of a sore throat, blocked nose, sneezing and a cough. His wife and two children were…
