Nicholas, a 43-year-old man, presented to a regional hospital with a first episode of severe central chest pain. He described a left-sided, non-radiating dull pain that began while exercising. At the time, he became sweaty and short of breath.
On arrival to the ED, he had an ECG, which was normal and had no dynamic changes. Nicholas was given sublingual glyceryl trinitrate oral spray, which relieved the pain completely within less than 10 minutes. Serial serological troponins were negative.
Nicholas was taking an angiotensin receptor blocker for arterial hypertension, but denies a history