Case 1

A 45 year old man presents to the ED with a 3 hour history of left sided chest pain. The pain is non-radiating. He finds the pain difficult to describe, but he says the pain is quite severe and sometimes varies with respiration. His pain is ongoing.  
 
There is no past history of any similar pain. He is a smoker and his father died of acute myocardial infarction at the age of 60. No other known coronary risk factors.  
 
On examination, his blood pressure is 210/100, but is equal in both arms. His pulse rate is 65bpm. Otherwise, clinical examination does not reveal any diagnostic features.