Patient presents with recurring chest pain, described as pressure-like sensation radiating to the left arm. Pain onset 3 days ago, worsening with physical exertion. Reports shortness of breath and occasional dizziness. No history of similar episodes. Family history of coronary artery disease (father, age 58).
BP 145/92 mmHg, HR 88 bpm, RR 18, SpO2 97% on room air. Temp 36.8°C. Cardiac auscultation reveals regular rhythm, no murmurs or gallops. Lungs clear bilaterally. ECG shows ST-segment changes in leads II, III, aVF. Troponin I: 0.04 ng/mL (borderline).
Hypertensive crisis with suspected unstable angina. Rule out acute coronary syndrome. Elevated cardiovascular risk given family history and current presentation.
Start Amlodipine 5mg daily. Order stress echocardiogram and serial troponins q6h. Cardiology consult for further evaluation. Patient counseled on lifestyle modifications including dietary sodium restriction and moderate exercise. Follow-up in 48 hours.