You are the AG-ACNP in a hospital

You are the AG-ACNP in a hospital setting and Mr. Jones, a 62-year-old African American man with a history of HTN and HLD was admitted last night for observation following intermittent chest pain x 1 week. Initial workup negative. TTE is pending before discharge. You are set to discharge him late today with follow-up with his PCP in 1 week. While you are completing your daily rounds, Mr. Jones complained of worsening crushing substernal chest pain radiating to his neck and jaw on the left side and severe heartburn that had been going on for about an hour. The patient’s visiting family member noticed he became diaphoretic and pale and called a rapid response. You arrive to assess the patient, he has shortness of breath, and he reports heartburn, nausea, and lightheadedness after the onset of the “crushing” chest pain. He denies palpitations, vomiting, headache, blurred vision, numbness/motor weakness, abdominal pain, urinary symptoms, or fever/chills. Allergies: NKDA ROS: Unable to complete at this time due to increasing SOB and distress. PHYSICAL EXAM: VS: HR 112, BP 88/60, Temperature 37.0, O2 90% on RA, RR 26 GENERAL: A&OX3, mild distress HEENT: PERRLA/EOMI NECK: Supple, no lymphadenopathy, no JVD CV: no murmurs, rubs, or gallops, tachycardia, no PMI displacement PULM: Tachipneic, Diffuse rales all lung fields ABD: Soft, NT/ND, + BSx4 EXT: No clubbing or cyanosis, palpable 2+ pulses all extremities NEURO: 5/5 BUE and BLE, CN II-VII grossly intact Diagnostics: EKG shows ST elevation in leads V1-V6, I and aVL, Chest X-Ray indicates cardiogenic pulmonary edema, troponin and cardiac enzymes pending Your Discussion should address the following: What are your top three differentials for this cardiac patient with rationale?

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