Conundrum

A 45 year old man presents with severe central chest pain for 3 hours associated with sweating and faintishness. He was asymptomatic prior to this.

His medical history is significant for well controlled hypertension for 10 years. He does not smoke and denies recreational drug use.

An ECG performed at a routine checkup a few months ago was completely normal.

Select Relevant Investigations
ECG

Performed

The ECG is in sinus rhythm with a rate of 110 bpm. There are ST elevations of > 1 mm in leads II, III, AvF and V4R.
Portable Chest X-Ray

Performed

The Chest X-Ray appears normal
Portable Echocardiography

Performed

The Echocardiogram shows hypokinesia of the right ventricle and inferior wall of the left ventricle. Right ventricular dilation is noted.
CT Pulmonary Angiogram

Performed

The CT Pulmonary Angiogram appears normal, with no evidence of intraluminal filling defects.

Select Relevant Management
GTN
IV Fluids stat
Intercostal Tube stat
Pericardiocentesis stat