ABSTRACT
A 66-year-old woman presented to the emergency department complaining of intermittent palpitations. The palpitations had been present for the past 3 months, initially occurring for a few seconds every couple of days but now lasting for several minutes 2–3 times daily. She also reported a 3-month history of dull, constant, right-sided chest pain. She had felt progressively more breathless and complained of unintentional weight loss over recent weeks. She denied any vomiting but was experiencing occasional diarrhoea. Her past medical history included peptic ulcer disease and osteoarthritis. She took regular 30 mg lansoprazole OD, 1 g paracetamol QDS and 30 mg dihydrocodeine QDS. She worked as an office manager, had a 40 pack year smoking history and drank 15–20 units of alcohol per week. She had travelled to France and Spain in the preceding 2 years.
