Myocardial Infarction
Patient Profile
F.M. is a 68-year-old white man who comes to the emergency department (ED) in the early afternoon with a 2-day
history of severe chest pain. The pain started on wakening the previous day. The pain increased during the night, but his
wife could not convince him to go to the hospital. He comes to the ED today because the pain is severe and no longer
relieved by rest.
Subjective Data
• Describes recurring chest pain for the past 6 months that was relieved by rest; the pain is a feeling of heaviness
in chest with no radiating pain to arm or jaw or accompanying nausea or dizziness
• Recently the chest pain has become severe and is no longer relieved by rest; is now slightly nauseated
• His father died of a heart attack at age 62 years
• Denies alcohol or drug use
• Smokes one pack of cigarettes per day
• Describes his lifestyle as sedentary
Objective Data
Physical Examination
• Blood pressure 180/96, pulse 98, temperature 99.8°F, respirations 20
• Height 5’11”, weight 210 lb, BMI 29.3 kg/m2
• Alert and oriented to person, place, and time
• Skin diaphoretic and clammy
• Heart rhythm regular, no murmurs or extra heart sounds
• Lungs are clear to auscultation
Diagnostic Studies
• Hemoglobin 14 g/dL
• Chemistry panel is normal
• Cardiac markers – pending
• Electrocardiogram showing changes that correlate with non–ST-segment–elevation myocardial infarction
(NSTEMI)
Interprofessional Care
• 0.9% NaCl infusing into IV catheter at 75 mL/hr.
• Nitroglycerin and morphine given with relief of pain
Discussion Questions
1. What are F.M.’s modifiable risk factors for coronary artery disease (CAD)? What are his non-modifiable risk
factors?
2. What is the difference between chronic stable angina pain and pain associated with myocardial infarction (MI)?
Patient Profile
F.M. is a 68-year-old white man who comes to the emergency department (ED) in the early afternoon with a 2-day
history of severe chest pain. The pain started on wakening the previous day. The pain increased during the night, but his
wife could not convince him to go to the hospital. He comes to the ED today because the pain is severe and no longer
relieved by rest.
Subjective Data
• Describes recurring chest pain for the past 6 months that was relieved by rest; the pain is a feeling of heaviness
in chest with no radiating pain to arm or jaw or accompanying nausea or dizziness
• Recently the chest pain has become severe and is no longer relieved by rest; is now slightly nauseated
• His father died of a heart attack at age 62 years
• Denies alcohol or drug use
• Smokes one pack of cigarettes per day
• Describes his lifestyle as sedentary
Objective Data
Physical Examination
• Blood pressure 180/96, pulse 98, temperature 99.8°F, respirations 20
• Height 5’11”, weight 210 lb, BMI 29.3 kg/m2
• Alert and oriented to person, place, and time
• Skin diaphoretic and clammy
• Heart rhythm regular, no murmurs or extra heart sounds
• Lungs are clear to auscultation
Diagnostic Studies
• Hemoglobin 14 g/dL
• Chemistry panel is normal
• Cardiac markers – pending
• Electrocardiogram showing changes that correlate with non–ST-segment–elevation myocardial infarction
(NSTEMI)
Interprofessional Care
• 0.9% NaCl infusing into IV catheter at 75 mL/hr.
• Nitroglycerin and morphine given with relief of pain
Discussion Questions
1. What are F.M.’s modifiable risk factors for coronary artery disease (CAD)? What are his non-modifiable risk
factors?
2. What is the difference between chronic stable angina pain and pain associated with myocardial infarction (MI)?
