case26 (A Sick Heart)

case26 (A Sick Heart) - A Sick Heart A 40 year-old diabetic...

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A Sick Heart A 40 year-old diabetic was evaluated in the emergency room for chest pain She had a history of hypertension 30 pack year smoking history. Her medications included antihypertensives and cholesterol-lowering agents She had a prior admission several years ago for a small uncomplicated myocardial infarct . She had angina for many years, averaging one bout of angina a week. Her usual angina lasted 10-15 minutes and was relieved by nitroglycerine There were no clinical changes until two weeks prior to her emergency room admission she began having daily anginal attacks that lasted 30 minutes or more In the hour prior to her admission she had awakened with severe chest pain, nausea, and dyspnea There had been severe unrelenting pain for 45 minutes and it had not been relieved by nitroglycerine HR 105. BP 100/50 (her usual BP runs about 155/95) She is obese, diaphoretic (sweating) has pale skin and labored respirations Rales were heard over both lung fields An EKG and serial cardiac enzymes were ordered.
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case26 (A Sick Heart) - A Sick Heart A 40 year-old diabetic...

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