ABSTRACT
A 28-year-old woman presented to the emergency department complaining of a 4-day history of intermittent chest pain. The pain was central and crushing in nature and was present whenever she exerted herself. There was no associated shortness of breath or nausea and the pain did not radiate elsewhere. It was usually 4/10 in severity and settled with rest. On the most recent occasion the pain had been more severe and lasted for around 15 minutes. On direct questioning, she described menorrhagia over the previous week. Her periods were regular and she generally experienced light menstrual flow. Her past history included pulmonary tuberculosis 5 years earlier, which had been treated in South Africa. She took no regular medications. She worked as a sous chef and did not smoke or drink alcohol. She had one long-term sexual partner. She was originally from South Africa but had lived in the United Kingdom for the preceding 5 years.
