A 58-year-old client arrives by EMS at 0842. He reports substernal pressure unchanged for 45 minutes despite resting since onset, with discomfort that spreads down the left arm and new breathlessness while sitting still. EMS gave chewable aspirin 324 mg before arrival. History includes hypertension, hyperlipidemia, and a 30-pack-year smoking history; he takes lisinopril and atorvastatin daily, and his father had a myocardial infarction at 62. A clinic note from last month lists BP 150/92, a resting HR of 68, and SpO2 93 percent on room air. Current findings: BP 152/94 in the right arm, HR 102 and regular, RR 20, T 37.0 C, and SpO2 93 percent, same as his clinic value with unlabored breathing. Lung sounds are clear, and there is trace ankle edema, unchanged from last month. He has pale, cool skin with diaphoresis and is anxious and asks if this is a heart attack.
A 58-year-old client arrives by EMS at 0842. He reports substernal pressure unchanged for 45 minutes despite resting since onset, with discomfort that spreads down the left arm and new breathlessness while sitting still. EMS gave chewable aspirin 324 mg before arrival. History includes hypertension, hyperlipidemia, and a 30-pack-year smoking history; he takes lisinopril and atorvastatin daily, and his father had a myocardial infarction at 62. A clinic note from last month lists BP 150/92, a resting HR of 68, and SpO2 93 percent on room air. Current findings: BP 152/94 in the right arm, HR 102 and regular, RR 20, T 37.0 C, and SpO2 93 percent, same as his clinic value with unlabored breathing. Lung sounds are clear, and there is trace ankle edema, unchanged from last month. He has pale, cool skin with diaphoresis and is anxious and asks if this is a heart attack.