Owen Adams

A 61-year-old man with known stable angina presents to the emergency department with a 2-week history of chest pain with a changed pattern — now occurring at rest, lasting longer, and radiating to the left arm, jaw and neck. Take a focused cardiac history, examine appropriately, risk-stratify, and formulate an urgent management plan.

1. 1Take a focused history of the chest pain using SOCRATES and characterise the changed pattern
2. 2Compare the current presentation with the known stable angina history
3. 3Screen for and exclude STEMI, aortic dissection and other life-threatening diagnoses
4. 4Explore cardiovascular risk factors and current medications
5. 5Verbalise a cardiovascular examination
6. 6Apply the TIMI risk score and justify investigation choices
7. 7Order urgent investigations including ECG, troponin, FBC and renal panel
8. 8State a working diagnosis with relevant differentials
9. 9Initiate antiplatelet, anticoagulation and anti-ischaemic therapy and arrange cardiology admission