1. ER-Conferene Group H Garcia, Geronimo, Go, Gozun, Hilario, Innocentes, Jose, Lazo

2. CC: Masakit ang Dibdib (Chest Pain) SL 77/F Widow Tondo, Manila

3. 3 Hours PTC Walked around one block Felt sudden chest pain Burning 8/10 Radiating to the back Not relieved by rest Drank small amount of water which lessened the pain Syptoms persisited hence the consult

4. Physical Exam BP: 130/90 PR: 118 RR: 28 Temp: 36.0

5. Conscious, coherent Warm moist pale skin Supple neck, no cervical lymphadenopathies Pale palpebral conjunctiva, anicteric sclera Symmetrical chest expansion, (+) crackles on left lung field Adynamic precordium, AB 6 th LICS MCL, irregularly irregular rhythm, (-) murmur Non tender, no mass (+) Bipedal edema

6. Ancillaries BUN15.22 mg/dL9-23 Creatinine1.73 mg/dL0.5-1.2 SGPT79.37 u/L0-31 Troponin I6.23 ng/mL0-0.05

7. Prothrombine time23.0010.3-14.1 secs. Normal control12.6 Prothrombine ratio1.9 INR1.9

8. Hgb101 g/L120 – 170 RBC3.27 x 10 12 /L4.0 – 6.0 Hct0.31 0.37 – 0.54 MCV94.9U 3 87 ± 5 MCH30.90 pg29 ± 2 MCHC32.50 g/dL34 ± 2 RDW 14.8011.6 – 14.6 MPV7.40 fL7.4 – 10.4 Platelet279 x 10 9 / L150 – 450 WBC6. 90x 10 9 / L4.50 – 10.0 Segmenters 0.72 Lymphocytes 0.28

10. ER stay Isodril 5mg 3x Aspirin 925 mg Clopidogrel 75 mg/ tab Atorvastatin 80 mg Esomeprazole 40 mg/IV

11. Adivise for Coronary Angigraphy Patient advise ICU admission

12. Impression: ASHD, HCND, CAD, NSTEMI I lateral wall LVH, AS, ……