Diagnosis: Chest pain
Treatment: Inpatient admission
The Inpatient admission was not medically necessary.

The patient has a past medical history significant for heroin abuse, now on methadone, and smoking. He presented to the ER for complaints of left-sided chest pain, non-exertional, intermittent, started after being arrested by the police.

The patient was hemodynamically stable. The ECG (electrocardiogram) revealed sinus bradycardia with no ischemic changes. The cardiac enzymes were normal. The patient was admitted to telemetry to rule out ACS (acute coronary syndrome). Echocardiogram revealed normal LV (left ventricle) systolic function. Stress test was offered, but refused by the patient. The patient was discharged.

This patient presented for evaluation of chest pain. The diagnosis of an acute MI (myocardial infarction) was ruled out by cardiac enzymes, which were negative. The ECGs were non-ischemic, and the echocardiogram revealed no wall motion abnormalities (WMA). There was no evidence of acute myocardial infarction, ACS, decompensated CHF (congestive heart failure), malignant arrhythmia or hemodynamic instability.

The standard of care for patients presenting with chest discomfort, and in whom the diagnosis of acute coronary syndrome is unclear, is observation in ED or chest pain unit with serial cardiomarker measurements to rule out an acute myocardial infarction, followed by a non-invasive ischemic workup (stress test, CT angiogram). This standard of care is in concert with ACC/AHA clinical guidelines. Therefore, the clinical information provided in the record submitted for review does not support medical necessity for this admission, and the care required could have been provided at a lower level of care.