This 53 year old man is an ex-smoker, with HTN well controlled by a single agent.
He presented to the ED under duress from his wife and GP with intermittent atypical pain which is sometimes worse with exertion, has a slight pleuritic variation, and radiates to shoulders. He mentions a more severe pain 2 days ago lasting a couple of hours with onset at rest. This was preceded by about three weeks of occasional slight exertional dyspnoea and chest tightness.
This is his ECG with mild residual discomfort:
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