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Chest pain with a twist
  1. Edward John Morley-Smith1,
  2. Joseph John2
  1. 1 Emergency Department, Musgrove Park Hospital, Taunton, UK
  2. 2 Urology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
  1. Correspondence to Dr Edward John Morley-Smith, Emergency Department, Musgrove Park Hospital, Taunton TA1 5DA, UK; edmorleysmith{at}

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Clinical introduction

A 52-year-old man presented with sudden onset chest pain immediately after eating. The pain was felt strongly in his back and was ‘indescribable’. He arrived via ambulance to the ED clammy, severely nauseated and in 10/10 pain. He had a background of depression and hiatus hernia. No cardiac risk factors. His observations were as follows: HR 100, BP 120/70, Sats 98% on air, lactate 3.6 mmol.L–1. His ECG showed normal sinus rhythm.


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  • Twitter @edmorleysmith1

  • Contributors I, EJM-S, coauthored the document, produced the images and gained the consent. JJ coauthored the document.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.