Acute Coronary Syndrome

HISTORY:

Chest pain for ‍ ‍hoursdays

Onset: ‍gradualsudden ‍during exertion ‍at rest, following ‍

Location: ‍retrosternalleft chest

Radiation: ‍none

Severity: ‍mildmoderatesevere, ‍012345678910 / 10

Type: ‍pressureheaviness

Pattern: ‍constantintermittent

Worsening factors: ‍with exertiondeep breath

Treatments tried: ‍nonerestsublingual nitroglycerinaspirin, ‍effectiveineffective

‍palpitations

‍shortness of breath

‍shortness of breath on exertion, ‍IIIIIIIV/IV

‍syncope

‍dizziness

‍lower extremity edema

‍fatigue

‍nausea

‍vomiting

‍diaphoresis

‍fever

‍cough

‍sputum



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Skin: ‍no rash

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍



ASSESSMENT:

‍Acute coronary syndrome ‍likelysuspectedpossible

DDx: ‍



PLAN:

- ECG

- Cardiac monitoring

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍troponin, ‍coagulation profile, ‍d-dimers

- Serial troponins every 3 hours x 3

- Chest X-ray

- Echocardiogram

- Coronary angiogram

- ‍Antiplatelets

- ‍Nitroglycerin

- ‍Beta-blockers

- ‍ACEs

- ‍Statins

- ‍Morphine

- ‍Anticoagulants

- Oxygen therapy to maintain SpO2 > 94%

- Referral to cardiologist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as chest pain or shortness of breath

- Go to ER if severe chest pain, severe shortness of breath, or fainting occurs