Diagnosis: Chest pain
Treatment: Inpatient admission
The Inpatient admission was medically necessary.

The patient is a male. He has a past medical history significant for HTN (hypertension), systolic CHF (congestive heart failure) with EF (ejection fraction) depressed to 35-40%, subsequently improved to 8%, homeless, and shelter resident. He presented for evaluation of chest pain.

The patient was hemodynamically stable. ECG (electrocardiogram) revealed inferior-lateral T-wave inversions. Troponin was mildly elevated. The patient was admitted for suspected ACS (acute coronary syndrome). Cardiac catheterization was planned, however the patient refused the procedure. Stress test was offered as an alternative, however the patient declined that as well. He was continued on medical therapy for suspected CAD (coronary artery disease). The patient was discharged with a planned outpatient clinic follow-up.

The patient presented with new onset chest pain, suspicious for unstable angina. The patient had multiple risk factors for CAD. ECG was abnormal, with T-wave changes suspicious for ischemia. Troponin was abnormal, suggestive of myocardial injury. There was a high index of suspicion for an ACS, and a cardiac catheterization was recommended, however the patient refused the procedure. He was treated medically for suspected CAD. Given the presentation, abnormal ECG and troponin, as well as clinical suspicion for an acute coronary syndrome/unstable angina, he would not be an appropriate candidate for an ED chest pain observation unit. It would be consistent with the current standard of care that this patient be managed in an inpatient setting. Therefore, the requested inpatient admission was medically necessary in this clinical setting.