Problem:
Antonio has been readmitted to the ward following an episode of chest pain last evening. He was assessed in the ED and pathology review indicated elevated Troponin levels. He has been diagnosed with a non-ST-elevation Myocardial Infarction (NSTEMI). He has been accepted for transfer to a tertiary facility and an Angiogram has been scheduled within 24 hours. He will stay in the ED while awaiting ambulance transfer. He requires serial Troponin levels and ECGs. Any chest pain must be reported.
His past history includes asthma and COPD, and his medications include:
Fluticasone Accuhaler 500mcg twice daily,
Salbutamol MDI 2 puffs twice daily and up to 8 - 10 puffs PRN during acute exacerbations of his COPD
Ipratropium Bromide MDI 2 puffs 4 times daily and up to 4 puffs during acute exacerbations of his COPD.
Antonio has a documented allergy to Penicillin.
It is the morning shift, and you are just entering the room post-handover to introduce yourself. You notice that Mr Antonio appears uncomfortable. You ask how he is, and he reports he hasdeveloped some chest pain following a walk to the toilet.
After having a 12 lead ECG, the ST elevation in leads 2, 3 and 4 was found. What does it mean?