ChrisPAinED Posted April 24, 2022 Share Posted April 24, 2022 A 60 y/o male went to a urgent care with shortness of breath following exercise. History of stable angina. Patient did say they had chest pain that went away after exercise unlike the SOB. Urgent care ordered a variety of test. CXR was normal. Troponin was elevated, CRP Normal, CBC normal, BMP normal. Troponin was 4.06 which the measurement we use it is normally 0.00-0.04 so it's a bit elevated. ECG showed sinus tachycardia in the mid 120s and some wide spread st depression. They were sent to us in the ED. Cardiology review the case just by phone and recommended nitro and repeat ECG every 30min and repeat troponin in 4 hours. New ECG after 2 hours was normal and troponin was trending down. Patient was given nitro and 2lpm NC for a sp02 of 91% which by 6hours patient was taken off oxygen and was able to maintain a 02 of 96-98%. Tachycardia went away with rest. SOB resolved and patient was given strict instructions to follow up with there cardiologist urgently. So any thoughts on what happened? Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 24, 2022 Moderator Share Posted April 24, 2022 a trop of 4 is 100x the upper limits of nl given the parameters you listed. That is a NSTEMI until proven otherwise...DDx includes PE with tachycardia, dyspnea, and hypoxia. Was a d-dimer done? Where I work this guy probably would have been recommended for admission for further inpatient eval, potentially stress echo, cath, etc. Hope he went home on maximal medical management with DAPT, beta blocker, statin, etc His heart score is at least 8 https://www.mdcalc.com/heart-score-major-cardiac-events 2 Quote Link to comment Share on other sites More sharing options...
ChrisPAinED Posted April 24, 2022 Author Share Posted April 24, 2022 7 minutes ago, EMEDPA said: a trop of 4 is 100x the upper limits of nl given the parameters you listed. That is a NSTEMI until proven otherwise...DDx includes PE with tachycardia, dyspnea, and hypoxia. Was a d-dimer done? Where I work this guy probably would have been recommended for admission for further inpatient eval, potentially stress echo, cath, etc. Hope he went home on maximal medical management with DAPT, beta blocker, statin, etc His heart score is at least 8 https://www.mdcalc.com/heart-score-major-cardiac-events Yes we ordered a D-dimer which was neg. We also gave a dose of heparin inpatient and discharged on a MMMP (max med management plan) and recommended admission but was refused for a personal reason. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 24, 2022 Moderator Share Posted April 24, 2022 13 minutes ago, ChrisPAinED said: Yes we ordered a D-dimer which was neg. We also gave a dose of heparin inpatient and discharged on a MMMP (max med management plan) and recommended admission but was refused for a personal reason. Great, glad to hear you guys covered all the bases. Hope you had him sign out AMA as well with one of those "you may die if you leave" notations. 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 24, 2022 Moderator Share Posted April 24, 2022 1 Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You can post now and register later. If you have an account, sign in now to post with your account.