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Case Study
Admission Dx: Three-vessel coronary artery disease, Non-Q-wave Myocardial Infarction, Hypertension, Congestive Heart Failure, and Hypercholesterolemia.
HPI: This is a 64-year-old white male transferred from a local hospital. The patient had a four day history of substernal non-radiating chest pain which occurred with exertion and walking one block. This pain was relieved with five minutes of rest. The patient continued to have episodes like this, and then presented to the hospital ER on the morning of Aug 24 with severe chest pain. The patient refused cardiac catheterization at this time. He continued to have unstable angina and on the evening of the 30th returned to his local hospital's ER with severe chest pain that was not improving with rest. At this time, he agreed to have a cardiac catheterization. Before they could take him to the catheterization lab, the patient developed ECG changes consistent with a non-Q-wave MI. After this diagnosis in the local hospital's ER, the patient was given an aspirin tablet immediately and then was administered thrombolytic therapy using streptokinase. He was transferred by helicopter to a tertiary care center for further treatment. It was felt that since the patient had on-going symtoms of ischemia and possibly had extensive three-vessel coronary artery disease, he would need coronary artery by-pass graft surgery.
PMH: Hypertension, Hypercholesterolemia, Glomerulonephritis, Migraine headaches, Hypothyroidism, Hemorrhoidectomy 1978
Allergies: IV contrast dye
Social History: No ETOH, No tobacco
Family History: Non-contributory
Physical Examination:
Temp 37.1°C HR 60 RR 20 BP 131/68 Review Of Systems:
HEENT: PERRLA, normocephalic and atraumatic Cardiovascular: sinus rhythm, normal rate, w/o murmurs, rubs, or gallops Respiratory: Breath Sounds are bilaterally coarse. Chest x-ray shows increased pulmonary congestion Abdomen: Soft and non-tender
