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Triage® Cardiac Panel: Rapid Rule-Out of Acute Myocardial Infarction
Chief Complaint:
Left-sided chest pain
Present Illness:
A 58-year-old man presented to the emergency department with complaints of left-sided chest pain while painting, starting yesterday. The pain was severe 7/10 (scale 1-10). Patient medicated self with one nitroglycerin tablet without relief. Patient states pain subsided after two more tablets of nitroglycerin were taken. This morning patient claims that 5/10 left-sided chest pain returned while taking a shower. Patient admits to taking one nitroglycerin tablet that relieved pain to 2/10. Patient denies shortness of breath, nausea or vomiting, or radiation of pain with either episode.
Past Medical History:
- CAD
- Hypercholesterolemia
- Emphysema for past 8 years
- MI in 1998
- Denies alcohol abuse
- Smoking: one pack per day for approximately 40 years
Emergency Department Assessment:
- Physical Exam
Temperature: 98.4 Pulse: 82
Blood Pressure: 110/74 Weight: 185
O2 Saturation: 96% Height: 5’11”
General: Alert and oriented
Chest: Wheezes on inspiration
Cardiovascular: Normal sinus rhythm, no murmur, no extremity edema
Neurological: Denies dizziness or blurred vision
Medications given in the emergency department: O2 , ASA, nitroglycerin sublingual x 1 with chest pain relieved, IV heparin
Initial Labs and Studies:
ECG: Normal sinus rhythm, no ST or T wave changes, Q waves noted in leads II, III, and AVF (indicating old MI). Serial ECGS continued with no S or T wave
abnormalities seen.
Chest X-ray: Cardiomegaly (enlarged heart)
Labs: Chemistry panel and CBC unremarkable
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