Chest Pain
CP is a 64-year-old male who presents to the emergency department (ED) via ambulance for chest pain. He was out shoveling snow from his driveway when he developed left anterior chest pain, pressure-type, radiating to his jaw and shoulder. Despite the cold weather, he was sweating. He also noted palpitations and shortness of breath, although he thought it was just because he was “a little out of shape.” He was afraid that something was wrong, so he asked his wife to call 911.
Past Medical History
Hypertension
Hyperlipidemia
Diabetes mellitus
Gout Medications
Hydrochlorothiazide, 25 mg once daily
Allopurinol, 300 mg once daily
Social History
Retired factory worker
Smokes one pack of cigarettes per day
Drinks about six beers per day (sometimes more)
Physical Examination
Well-developed obese man in moderate distress
Height: 69 inches; weight: 252 lbs.; blood pressure: 172/110; pulse: 92; respiration rate: 16; temperature: 98.7°F
Lungs: Scattered bilateral wheezes
Heart: Regular with grade II/VI systolic murmur
Extremities: No edema
Labs and Imaging
Complete blood count with mild leukocytosis (WBC 12.9k)
Potassium: Low at 2.9 mEq/L
Glucose: 252 mg/dL
Troponin I: 1.7 ng/L
Uric acid: 11.1 mg/dL
EKG: ST segment depression with T-wave inversion over lateral leads; no pathologic Q waves Next Steps
CP’s admitting diagnoses are non-ST segment elevation acute coronary syndrome, hypertension, diabetes mellitus, obesity, alcohol abuse, hyperuricemia, and smoker
Discussion Questions
1. What medications should be instituted for CP?
2. What medications should be continued after discharge?
3. What lifestyle modifications can be recommended for CP?
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