A 42 y male with a history of Diabetes and Hypertension walks into your Emergency Department with a complaint of chest tightness. He was just seen at a previous well-respected hospital where he had the same complaint. The gentleman had been arranged for a follow up cardiology appointment. The pain has been pretty constant, giving him some shortness of breath. He also has noticed that when he climbs the stairs from the train (a climb he does daily) he noticed some worsened dyspnea about 2 days ago. Since then he has been able to do it just fine. The pain does not radiate to his arm or jaw and is not positional. He denies any pulmonary embolism type symptoms (for all you avid PE-ologists). His pain had gotten slightly better since the visit to the last hospital but this morning around 4 AM the pain came back. He was sweating a little bit with the pain. He had taken Motrin 800mg before coming and now the pain has totally resolved. His EKG looks like the one below.
What tests do you run on this gentleman? Is the EKG concerning for ACS? If he has negative cardiac enzymes do you let him go to the Cardiologist? What is your threshold for admission? What would elements of this or any patient’s history when it comes to chest pain make you push the admit button? In sum…what is your management of this situation?
I look forward to your answers and sharing your knowledge and experience with me.