“Tight chest on the third floor”

Classic stable angina is a story, not a test: constricting exertional discomfort relieved by rest within minutes, in a smoker with premature paternal CAD — name it, don’t collude with "strain". A falling exertional threshold is crescendo physiology and compresses the timetable. Management starts in the consultation (aspirin, statin per NICE NG238, a first-line anti-anginal per NICE CG126, GTN with the CG126 teaching — second dose after 5 minutes, 999 if the pain has not gone 5 minutes after it — RACPC referral, BP/bloods/ECG) — and the work prescription is clinical content: a self-employed man follows the plan that keeps his crew paid ("re-deployed, not signed off"). The hidden agenda is the father — MI at 52, the armchair, the arithmetic — answered with the warning-vs-damage distinction that makes attendance feel like winning, not surrendering.