The patient who presented to the emergency department (ED) with chest pain described chest pain as aching, squeezing chest pain in the left chest and left arm when walking. The pain resolved with rest. Also, occasionally the pain happened at night. Two days prior to presentation the patient had nausea with episode of chest pain.
The patient has history of coronary artery disease (CAD), and coronary stent placement in the past. The health plans determination of medical necessity is upheld in whole .The ECG did not reveal ischemia the troponin was normal. The nuclear stress test did not reveal evidence of ischemia. The echocardiogram was abnormal with evidence of left ventricular hypertrophy (LVH), but there were no wall motion abnormalities.
The patient remained stable on medical management. The patient was evaluated and treated however, the level of care for this patient did not meet criteria for inpatient admission. The care could have been provided at a lower level.