• John Barker is a previously fit, though overweight, 49 year old builder who smokes 30 cigarettes per day.
• He has not seen his general practitioner for 10 years.
• After a rushed lunch, he develops a feeling of indigestion-like discomfort in the epigastrium and lower part of his chest.
• He has had similar discomfort over the previous two or three weeks, sometimes related to exertion, but has ignored the symptoms. He feels that the epigastric discomfort is getting worse.