Medical History

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?