Diagnosis: Chest tightness and dyspnea
Treatment: Inpatient hospital admission
The inpatient level of care was not medically necessary.
This patient presented with hypertension, atypical chest pressure for four days, and risk factors for CAD. There was no evidence to suggest active ischemia. While it is appropriate to rule out presence of ACS, the tests and treatment to accomplish this in this case did not require inpatient level of care. The presence of an increased thrombolysis in myocardial infarction (TIMI) score represents the possibility of having ACS, but does not represent the presence of ACS itself. In this case, the symptoms were atypical, present for four days without changes in enzymes and unlikely to be representative of acute coronary syndrome. Exam and cardiac findings were
normal. Biomarkers and EKG showed no evidence of acute ischemia. CXR was normal. Echocardiogram showed no wall motion abnormality. Nuclear scan was negative for CAD.