Patient Case - ABPrint Cases (PDF)
Patient Case AB Introduction
AB is a 50-year-old man who presents to the emergency department (ED) with radiating substernal chest pain that began 2 hours earlier while he was watching television. He rates the pain severity 8 on a scale from 1 to 10 with 10 for the worst pain imaginable. The hospital has a cardiac catheterization laboratory and team standing by.
The medical history, preadmission medications, social history, physical examination/review of systems, pertinent laboratory data, and electrocardiogram (ECG) findings for AB are presented below and on the next screen. This information will be accessible using a button on the tool bar throughout this case study.
Medical History
Hypertension x 20 years
Dyslipidemia x 10 years
Preadmission Medications
Enteric-coated aspirin 81 mg orally once daily
Metoprolol tartrate 25 mg orally twice daily
Atorvastatin 40 mg orally once daily
Social History
Cigarette smoking: 2 packs per day for 30 years
No alcohol use
Physical Examination and Review of Systems
Blood pressure: 150/92 mm Hg
Heart: regular rate (86 beats per minute) and rhythm, S1 and S2 present
Oxygen saturation on room air: 95%
Height: 5'10"
Weight: 80 kg
Pertinent Laboratory Data
Troponin: "positive"
Serum creatinine: 1.0 mg/dL (normal range: 0.7-1.5 mg/dL)
All other test results within normal limits
Electrocardiogram Findings
ST-segment depression in leads II, III, and aVF
Diagnosis
AB appears to have NSTEMI based on his history of symptoms, physical examination, ECG, and laboratory test results. AB's chest pain persisted for more than 20 minutes despite rest, so he has ACS, not stable angina. The elevated troponin reflects myocardial infarction (MI). The ECG does not indicate ST-segment elevation.
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