ECG performed on admission shows sinus rhythm and deep ST depression in leads II, III and a VE

Serial cardiac enzymes Repeat ECG in 4 hours Chest X-ray Full blood count

Urea and electrolytes, glucose, cholesterol and triglycerides

Oxygen and cardiac monitor Aspirin (already given) Nitrate infusion Enoxaparin

Diltiazem (beta-blocker contraindicated owing to COPD) Advice to stop smoking

When stable:

1. review anti-anginal management

2. referral for mammography and fine needle aspiration of breast lump

3. spirometry and assessment of inhaler technique.

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