the patient had an echocardiogram on day two of admission , which revealed a mildly dilated left atrium , mild symmetric lvh , normal lv cavity size , mild region lv systolic dysfunction , arresting regional wall motion abnormality including focal apical hypokinesis , a normal right ventricular chamber size and free wall motion , a moderately dilated aortic root , a mildly dilated ascending aorta , normal aortic valve leaflet , normal mitral valve leaflet and no pericardial effusions .


he was transferred to the cc for monitoring and he denied having further pain , shortness of breath , nausea or vomiting .

shortness of breath
nausea
further pain
vomiting


the chest pain persisted afterwards and a relook catheterization was performed that revealed no occlusions .


the right heart catheterization revealed a cardiac output index of 4.11 and 2.15 respectively .

the right heart catheterization
a cardiac output index


captopril 6.2 3 x a day and titrated up .


skin was strong build and was in no apparent distress .


blood pressure 156/67 , pulse 80 and respiratory rate 14 .


ra pressure was 13 , rv pressure 45/7 , wedge 27 and pa pressures of 42/21 .

pa pressures
ra pressure
rv pressure
wedge


a hepacoat stent was placed with no residuals but good flow after nitroglycerin and diltiazem .

a hepacoat stent
diltiazem
nitroglycerin


there were no lifts or heaves on examination .


he was told to return to the emergency department if he had any chest pain , pressure , difficulty breathing , nausea , light-headiness or dizziness .

dizziness
nausea
any chest pain
difficulty breathing
pressure
light-headiness


his pmi was two finger breath width in the fifth intercostal space lateral to the midclavicular line .


the patient did not have any carotid bruits , abdominal bruits or femoral bruits .

femoral bruits
abdominal bruits
any carotid bruits


hypertension was managed with beta blocker and ace inhibitor and integrilin was continued post mi for 18 hours .


heparin and nitroglycerin drip were started with 10 mg of iv retavase half dose .


his heart was regular with no murmurs , rubs or gallops and his radial and dp pulses were both 2+ bilaterally and equal .


his abdomen was scaphoid , nondistended , nontender with positive bowel sounds .


antihypertensive medications that the patient could not identify .


serial ck s were followed with a ck peak of 433 .


he was transferred to the north adams regional hospital for catheterization .


aspirin 325 mg q.d. , plavix 75 mg q.d. , lipitor 20 mg q.d. , nitroglycerin 0.3 mg sublingually p.r.n. chest pain or pressure or shortness of breath , lisinopril hydrochlorothiazide 20 / 12.5 mg q.d. , atenolol 25 mg q.d.

aspirin atenolol nitroglycerin plavix lisinopril lipitor hydrochlorothiazide


plavix was started at 75 mg a day , lipitor 20 mg per day , metoprolol 25 mg twice a day to be titrated up as tolerated and on day two of admission an ace inhibitor was started .

an ace inhibitor
lipitor
metoprolol
plavix


on day two of admission , the patient ambulated with pt and was moved to the regular floor .


a lipid panel was checked and found to be within normal limits , although it was noted this was in the post mi setting and the lipid panel could be falsely low .


the patient was given a low fat / low cholesterol diet .


the right calf site had minimal ooze and no hematomas or bruits .


this is a 54 - year-old man with significant coronary artery disease risk factors , positive family history , smoking history , hypertension and gender who presented with an st elevation mi status post lad stent , complicated by no residuals requiring nitroglycerin and diltiazem for good flow .


cardiac catheterization and stent placement in the mid left anterior descending artery .


the patient was afebrile .


the patient was told repeatedly that he needed to stop smoking and was given a nicotine patch and his primary care provider was called to discuss outpatient plans to help the patient stop smoking .


for renal , his creatinine was monitored and the dye load and the catheterization .

the dye load
his creatinine
the catheterization


the patient was advised to have a low fat / low cholesterol diet , was cleared by pt and advised to do cardiac rehabilitation .

cardiac rehabilitation
a low fat / low cholesterol diet


once at hahnemann general hospital he received heparin and integrilin .


the patient was normal volume and displayed no evidence chf signs or symptoms .


the patient was told he could return to work after two weeks of rest , given that his work required a high level of exertion and the patient was also given a prescription for a transdermal nicotine patch 14 mg the be used for up to 2 weeks until cravings remitted .


he denied ever having any chest pain , chest pressure , shortness of breath , dyspnea on exertion and he was discharged to home .

chest pressure
shortness of breath
any chest pain
dyspnea


they were normal and did not change and the patient received pneumatic boots for dvt prophylaxis .


significant for a brother who had an mi at age 61 .


he was advised the importance of each of his and compliance with each of these medications and was told he needed close followup with a cardiologist .


each episode lasted approximately 15 minutes in duration and resolved on their own .


he had normal bowel movements and had gi prophylaxis throughout his stay .


2. hypertension .


the patient was pain free and doing well .


the risk factors were addressed .


for his coronary artery disease , aspirin was started at 325 .


coronary angiography revealed left main , left circumflex and rca normal and left lad with 99% midstenosis .


he was advised to take all of his medications .


only hypertension .


1. st elevation myocardial infarction .


he was anicteric with moist mucous membranes .


this morning while landscaping the patient had unremitting 12-05 pain with shortness of breath and diaphoresis .

diaphoresis
unremitting 12-05 pain
shortness of breath


rhythm was maintained at normal sinus , monitored on telemetry without ectopy .


for hematology , the patient 's hematocrit and platelets were monitored after the catheterization .

the catheterization
platelets
the patient 's hematocrit


no jvd or increased jvp was appreciated at 0 degrees .


the patient denies having any drug allergies .


this is a 55 - year-old caucasian speaking male who is a smoker and has a family history of coronary artery disease , as well as a personal history of hypertension , who experienced multiple episodes of 10/10 substernal chest pain radiating down his left arm last night with his daily activities .

coronary artery disease
10/10 substernal chest pain
hypertension


his extremities were warm , pink with no edema .


he presented to deaconess-nashoba hospital hospital and the first ekg was found to have st elevations in v1-v3 of 1-2 mm with t wave inversions in v4-6 , i and l , which progressed to 3-0167 w. seventh ave. elevations within 20 minutes .

t wave inversions
st elevations in v1-v3


he was laying flat , very tense .


his electrolytes were monitored and repleted carefully .


his lungs were clear to auscultation .