Chest pain( CAD/Stable Angina and ACS)Problem: chest painPrimary Impression: Unstable Angina/NSTEMI, (What wall based on ECG), Killips classification?Patients presenting symptom is chest pain, which is typically located in the substernal/ sometimes in the epigastrium, that radiates to the back, left shoulder, or left arm. It is rest pain, post-MI, prior ASA, DM. Dyspnea and/or epigastric discomfort might be present. The patient also had a history of prior chest pains, diagnosed with hypertension, or had history of high lipid levels. Although the patients physical exam is unremarkable, patient may present with diaphoresis, cool skin, sinus tachycardia, S3 sound, or rales. Since diagnosis of UA is based largely on the clinical presentation, hence, this is my primary consideration. Risk factors: >65 yrs old, 3 or more risk factors for CAD, 2 or more episodes with the 24hrs, elevated cardiac marker, ST dev >.5mm, DM, LV dysfunction, renal dysfunction, elevated BNP and CRP. ECG also revealed injury to what wall? Patient belongs to Killips Class? ( Class I- no signs of pulmonary congestion, II-moderate heart failure, bibasal rales, s3 gallop, tachypnea, inc JVP, hepatic congestion, III- severe heart failure. >50% of lung fields or pulmonary edema, IV-shock with 95%2. Diet: Low salt, low fat diet3. Activity: CBR without TP4. Position: Moderate High Back rest5. IVF: PNSS at KVO rate6. Anti-embolic stockings7. Monitor V/S every hour, temp every hrs; I/O every shift8. Nitroglycerin 0.4mg SL up to 3 doses every 5min for chest pain relief9. Aspirin 160-325 mg stat dose then 80mg tab BID PC with or without Clopidogrel 75mg tab OD10. Consider thrombolytic therapy11. Heparin for large anterior wall MI, atrial fib, and persistent chest pains, or presence of LV thrombus12. Beta blockers: Metoprolol 50mg to 1tab every 8-12 hours should be continued indefinitely if without contraindications13. ACE inhibitors: Captopril 25mg tab every 12hrs14. Consider statins: Atorvastatin 20mg OD

PericarditisMost common pathologic process involving the pericardium, classified as acute(6months). Four principal diagnostic features: chest pain, which is often pleuritic, relieved by sitting up and leaning forward, intensified by lying down; pericardial friction rub; ECG changes; and pericardial effusionDiagnostics:Definitive: Transesophageal 2D Echo(TEE) - most widely used imaging technique with 90% sensitivity; can identify accompanying cardiac tamponade and cardiac thickeningSupportive: 1. Chest Xray may show Ewarts sign which is compression of the base of left lung due to tamponade; water-bottle configuration2. CBC detect hematologic status and rule out infectious process3. Urinalysis to detect complications and asses kidney function

Therapeutics:Definitive: Pericardial resection be carried out early in the courseSupportive:1. Diet : DAT2. Decrease sodium intake to