Diagnosis: Shortness of breath; chest pain
Treatment: Inpatient admission
The Inpatient admission was medically necessary.

This patient presented with chest pain, dizziness and shortness of breath. He had a known history of ischemic heart disease and prior open heart surgery. Upon presentation, ECG was abnormal, revealing ST depressions in the precordial leads, right bundle branch block and a prolonged QT interval. High sensitivity troponin levels were mildly elevated. He had an elevated HEART (History, EKG, Age, Risk factors, initial Troponin score) consistent with a high risk of future cardiac events. (Reference 1, 2) He was admitted and ultimately further work up revealed no dynamic ECG changes.

Based on the patient's high risk score using both the HEART and TIMI (thrombolysis in myocardial infarction) risk stratification, admission for observation and work up was indicated. Risk assessment of patients presenting with chest pain and ST changes on ECG as well as negative cardiac enzymes was performed by Sanchis et al. (Reference 2). Using their risk stratification schema, this patient would have a moderate to high risk of future myocardial infarction or death within one year. Admission to the hospital for further testing and treatment was indicated.