CASE HISTORY
Your first case is an 80 year old male. He was admitted two weeks ago with chest pain, but despite your colleagues' best efforts, he died.
He had a 6 month history of angina, treated with GTN 2-3 times per week. He had an exercise tolerance of 100yds but was getting worse. He was also an ex-smoker- stopped 10 years ago- and did not drink, with no other significant medical history. Other drugs taken were Aspirin, GTN, Allopurinol and Diltiazem.

On examination:

• Apyrexial, 80bpm, bp120/60, normal heart sounds.
• A few bilateral crepitations in lung fields
• No abdominal masses
• An ECG was taken upon initial admission- see image.

The patient suffered several bouts of pain during admission, treated with GTN. He was discharged and readmitted a week later with chest pain not responding to GTN, for which he was given GTN and IV heparin.
The chest pain and breathlessness increased, and a tachycardia of 120bpm developed, with crepitations in both midzones. He then developed bradycardia, reduced respiratory rate, then went into asystole.

Resuscitation was unfortunately unsuccessful.