Mr Rajesh Patel is a 48-year-old taxi driver who presents to his local Emergency Department (ED) with a crushing central chest pain that radiates to h

Case scenario:

Mr Rajesh Patel is a 48-year-old taxi driver who presents to his local Emergency Department (ED) with a crushing central chest pain that radiates to his left arm. He has rapid breathing, seems very anxious and reports feeling nauseated.
Mr Patel does not smoke. He drinks alcohol when not working, often about 20 units or more a week. Due to his shift work doing day and night shifts, his eating patterns are irregular, tending to eat a large meal once he has finished working after 10pm or during his night shift; and he snacks on high calorie and high carbohydrate-based foods while working.

Mr Patel has hypertension which he takes an angiotensin-converting-enzyme (ACE) inhibitor for. He has a family history of cardiovascular disease (CVD), with his father having a first myocardial infarction (MI) before he was 55 years old. On this occasion the emergency medical treatment was successful but he died of a myocardial infarction before he was 65 years old.

Mr Patel and his family were on their way to visit his brother, sister-in-law and children when his chest pain began. He arrived at the ED with his wife, mother and two children. Mr Patel is employed on a zero hours contract and he is the only member of the family whose work is income-generating. He very keen to be treated quickly, so he can return to his job as soon as possible.
His wife is extremely worried for Mr Singh and has been observed to be crying when she thinks no one is looking. She has confided in a member of the nursing team that her anxiety levels have been high since they began their journey today and she has described symptoms consistent with mild agoraphobia having not been out of the house much at all since the pandemic started. She has also mentioned that she is a full-time carer for her mother-in-law since her diagnosis of dementia a year ago.
Mr Patel’s mother presents as moderately confused, disoriented and anxious, and has been observed to be wandering around the ED at times. She appears to respond well to her daughter-in-law and becomes much calmer and contented for a period of time when she has physical contact with her.

Mr Patel’s children, who are twelve and nine years old, are not fully aware of what is happening and have asked a number of times when he will be allowed to leave, so they can go and visit their family.