CC: Chest pain and tightness HPI: 58 y/o female with substernal chest tightness. Onset 1 hour ago while climbing stairs. Pressure-like, 6-7/10. Radiates to left arm. Associated SOB, diaphoresis. Rest provides mild relief. PMH: HTN (on lisinopril), FHx: Mother MI at 62
Vitals: BP 158/94, HR 102, RR 20, SpO2 95% RA General: Anxious, mildly diaphoretic CV: Tachycardic, regular rhythm, no murmurs Resp: Clear bilaterally Ext: No edema, pulses intact
Working Dx: Acute Coronary Syndrome - R/O MI Classic presentation with substernal pressure, left arm radiation, diaphoresis. Multiple cardiac risk factors. Differential: 1. Acute MI 2. Unstable Angina 3. Stable Angina
1. 12-lead ECG STAT 2. IV access 3. Aspirin 325mg PO given 4. Cardiac biomarkers 5. Continuous monitoring Pending: Cardiology consult, serial troponins, CXR