HISTORY OF PRESENT ILLNESS:

Morning prior to admission (7AM), patient noted onset of chest tightness located on the left parastenal
area radiating to the left arm, lasting for around 10 minutes with PS 9/10. No dyspneic episodes, no
diaphoresis, no nausea nor vomiting, no fever, no cough, nor colds. Condition tolerated, no meds taken.
Chest tightness recurred with the same characteristics and duration, twice (12nn, 7pm) during the day.
This was associated with dull /Magnesium Hydroxide + Simeticone (Kremil-S) with no relief, thus opted
consult. epigastric pain. No medications were taken nor consult done. Three hours PTA (12mn),
condition recurred, now with worsening chest pain, with PS 10/10. However, this time, pain did not
subside; patient took Aluminum

COURSE IN THE WARDS: At Emergency room, patient was conscious, coherent, NIRO with BP of 110/90,
HR 82, regular, 20, Temp 35.9, and oxygen saturation of 98% RA. Patient coml.., of ch.st tightness and P.,
with pain score cf radiating to the parasternal area with radiation to the left arm. Pertinent physical
exam show. cowl cLarnm-, extremities, clear breath sounds, with strong pulses. Chest xray was
unremarkable. Supplemental oxygen *a given at RPM. Patient was attached to a cardiac monitor, 12L
ECG showed Sinus Rhythm with ST eleva,.sn a V2-V6 with Trop I elevated at 1.074. Cath lab was then
actorated and patient underwent percutanecus corona, intervention — coronary angioplasty with
slanting (x2). No post op compkations — patent a..., but slit complains of chest pain with pain score ocl
6/10, thus patient was given Morphine 3r g rear new Patient was also started on Aspirin, ISMN,
Ticagrelor, and Carvatt.bi post-op. Patient was aiso start. w.tn Dobutamine and Tirofiban (Aggrastat) to
maintain SBP .10OrnmHg and to consume. Patent was then transferred to CCU for close monitoring.
Upon receiving at CCU, patient remained stable although had fever Trnaa 37.80 with occasional PACs on
cardiac monitoring with pertinent PE showing prominent . heart sound. On CCU day 1 (10/7/20), patient
still had !ow grade fever 37.8C with no chest pain. Low dose Dobs.tamme at 2.Smkrn was restarted since
patent had BP as low as110/SO. Morn, tabs shcrwed norm, craa and muss., with CBC showing slightly
decreasing WBC of 11 6 from 12.4. tvabradine Smg was WO. due to tachycardia as high as 110 while
awake. Blood CS x 2 was also taken du* to persistence of fever es Min as 38.1C with Celotiam lgm Q8H
IV started. On CCU day 2 (10/8/20), patient had 4 episodes of non-sustained ventricular tachycardia
Pave around 2.1 seconds each. Electrolytes, TSH, FT4 were taken which were are normal except for •
s4ghttv 17us iond•4 calcium at 1.10. Also not. were PVCs symptoms were noted. In the evening, patient
again had non-sustain. ventrscuter Uchycarche 10 seconds. Calcium gluconete 1 amp IV was given with
no recurrence tAer,e, On CCU day 3 (10/9). Patient had no recurrence of non-sustained v-tech and
fever_ Ps.. Wes ttwn dew.. OK for transfer out of CCU. On word' day 1.1 10/1041, not. Improved
conditbn. Ntal signs wens sta.. Had cheat tighbwiss but nosed decreased Intensity. Carveddol Increased,
patient discharegd Imryrovexs tM Nat slay.