ACS

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of chest pain

Onset was ‍gradualsudden ‍during exertion ‍at rest, started ‍whileafter ‍

Location is ‍retrosternalleft chest

Radiation ‍none to ‍

Rated at ‍012345678910 / 10 ‍

Described as ‍pressureheaviness

Pattern ‍persistentintermittent

Worsening factors: ‍with exertiondeep breath

Alleviating factors: ‍nonerestsublingual nitroglycerinaspirin, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍palpitations

‍shortness of breath

‍shortness of breath on exertion, ‍IIIIIIIV/IV

‍syncope

‍dizziness

‍lower extremity edema, ‍rightleftsymmetrical

‍fatigue

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍diaphoresis

‍fever, up to ‍°, over ‍ ‍hoursdays

‍cough, ‍non-productiveproductive of ‍clearcolored phlegm



Contributing factors:

‍tobacco use

‍sedentary lifestyle

‍obesity

no history of: ‍angina, ‍myocardial infarction, ‍high cholesterol, ‍high blood pressure, ‍diabetes, ‍pulmonary embolism, ‍gastroesophageal reflux disease, ‍anxiety disorder

no family history of: ‍heart disease





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Acute coronary syndrome ‍likelysuspectedpossible

DDx: STEMI, NSTEMI, unstable angina, stable angina, atypical chest pain, non-cardiac chest pain, hypertrophic cardiomyopathy, coronary artery spasm, pericarditis, myocarditis, pulmonary embolism, pneumonia, pneumothorax, aortic dissection, GERD, esophageal disorders, peptic ulcer disease, costochondritis, musculoskeletal pain, anxiety/panic disorder





PLAN:

Investigations:

- 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

Treatments:

- ‍Antiplatelets

- ‍Nitroglycerin

- ‍Beta-blockers

- ‍ACEs

- ‍Statins

- ‍Morphine

- ‍Anticoagulants

- Oxygen therapy to maintain SpO2 > 94%

Further care:

- Referral to cardiologist

- Follow-up in ‍ ‍daysweeks

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

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