Description

Case Details The patient was a 65 years old non-diabetic male, who smoked 5 cigarettes a day and who although having a sedentary lifestyle had, until 2 months before presentation, been able to walk a mile comfortably (and did most days). Only recently had he felt some chest tightness on exertion, after reducing distances. He had presented with a slightly worse pain than usual, accompanied by anterior T wave inversion on the ECG and was referred to the local hospital by his GP. A troponin T level of 0.05 was found and a non-ST elevation acute myocardial infarction (NSTEMI) was diagnosed. He was admitted to the coronary care unit, given aspirin 300mg orally, low molecular weight heparin subcutaneously and intravenous nitrate. Oral atenolol 50mg was prescribed. His symptoms disappeared rapidly. An assessment of risk placed him in between the low and intermediate categories. An exercise test was arranged for 2 days later with a view to later angiography as required. Unfortunately on the morning on which the exercise test was to be performed, he had a fatal cardiac arrest.