1. Subjective
Patient’s chief complaint: A man aged 69 comes to the emergency room with a sharp pain to his chest’s left side, lasting between 30 and 40 mins and then subsiding.
History of present illness: The pain has woken him up thrice in the last 7 days. He claims the pain first started roughly six months ago. Initially, however, the pain used to surface only occasionally, commonly while he was doing gardening. The patient’s past medical history reveals a diagnosis of hypertension twenty-five years back.
Precipitating/alleviating factors: The patient has been smoking a half-cigarette pack daily for the last forty-five years.
Family History: The patient has lost two brothers and his dad to heart disease. The patient does not report any other significant illness history in the family.
Social History: His typical pastimes include sharing a drink with pals and gardening.
Review of Systems: From a physical examination of the patient, no heaves, acute distress, hepatojugular, carotid bruits appreciated, abnormal pulsations, thrills or tenderness to palpation have been observed. All lung fields reveal clear breathing sounds.
2. Objective
Diagnostic Study: Acute Coronary Syndrome (ACS)
ACS constitutes a continuum of states of myocardial ischemia including unstable angina, ST-elevated and non-ST elevated MI (myocardial infarction). ACS has been linked to significant mortality and morbidity, significantly burdening the US healthcare system financially. Its diagnosis commences with an in-depth clinical evaluation of presenting patient symptoms, cardiac troponin level, electrocardiogram, and prior medical history examination. Early stratification of risk may help providers ascertain which approach ought to be adopted: initial conservative or early invasive, besides facilitating ascertainment of appropriate pharmacologic treatments (Smith JN, 2015).
ACS’s characteristic symptom include substernal chest pain, described typically as a pressing or crushing feeling, that radiates to the left arm and jaw. This doesn’t, however, manifest in all cases. Presenting symptoms may be highly subtle and vague with the main complaints commonly being breathing difficulties, isolated pain in the left arm or jaw, light-headedness, nausea, diaphoresis, weakness, and epigastric pain (Singh & Grossman, 2017).
3. Assessment
Pathophysiology: ACS’s underlying pathophysiology is partial reduction in heart musculature blood flow, normally secondary to thrombus formation and plaque...
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