Myocardial Infarction Recognition — MFDS Part 1 MCQ

Correct answer: D — Myocardial infarction

The diagnosis to suspect is myocardial infarction. Persistent crushing central chest pain with autonomic symptoms such as sweating and nausea is characteristic of an acute coronary syndrome. Failure of the pain to improve with rest and the patient's prescribed GTN increases concern for myocardial infarction and warrants an immediate 999 call. GTN response alone cannot confirm or exclude myocardial infarction; definitive diagnosis requires hospital assessment, including ECG and cardiac biomarkers. Stable angina usually follows a familiar pattern and improves with rest or GTN. A panic attack may cause chest discomfort, sweating and palpitations but is less consistent with persistent crushing pain. Vasovagal syncope and postural hypotension principally cause light-headedness, hypotension or transient loss of consciousness rather than this chest-pain syndrome.

Reference: NHS, How and when to take glyceryl trinitrate (GTN), reviewed 12 April 2023. https://www.nhs.uk/medicines/glyceryl-trinitrate-gtn/how-and-when-to-take-glyceryl-trinitrate-gtn/