FLORENCE BLACKMAN 66 YEAR OLD
FEMALE CHEST PAIN I-HUMAN CASE
STUDY PRACTICE SCRIPT UPDATED 2026
TESTED SOLUTIONS
⫸ A 70 year old woman presents with chest pain that began 2 hours
ago. She describes it as substernal radiating to her jaw and left shoulder;
there is no other area of pain or radiation. She took an aspirin at home
but the pain is not better. She also took 3 sublingual nitroglycerin tablets
en route to the hospital. Her initial EKG shows ST elevation in the
anterior leads >2mm and ST depression in the inferior leads. The nurse
has already administered oxygen, placed her on an EKG monitor, and
attained IV access. You order beta-blockade and nitroglycerin for pain
relief, and the supervising resident asks you which of the following
should be done next:
A. Call her primary care physician.
B. Send her to radiology for a good-quality chest X-ray.
C. Give her a GI cocktail to check for pain relief from this.
D. Call cardiology for a decision between thrombolytic and
percutaneous coronary intervention.
E. Call cardiology Answer: The answer is D. This patient is having an
acute myocardial infarction. AMI is defined when two of the following
three findings are present: clinical history of chest pain of at least 20
minutes duration, EKG changes and/or positive myocardial enzyme
testing. This patient has ST elevation with concomitant ST depression in
contiguous leads with chest pain. She needs immediate thrombolytic
therapy or cardiac catheterization; if percutaneous coronary intervention
, (PCI) can be achieved within 90-120 minutes of emergency department
arrival, the literature supports its selection over thrombolytic therapy as
primary intervention. In preparation for either thrombolytic therapy or
PCI, you need to control her pain, maximize O2 delivery, decrease work
of the heart and inhibit platelet function. O2, nitroglycerin and morphine
will increase O2 delivery to the heart. A beta blocker, which should also
be administered to AMI patients who lack contraindications, will
decrease the work of the heart, and aspirin will inhibit platelets. A
glycoprotein IIb/IIIa-inhibitor should also be administered - selections
will depend on the exact treatment course chosen for the patient.
Anticoagulation with low molecular weight heparin or unfractionated
heparin (dose being dependent on exact treatment course for patient)
should be started if there are no patient historical or chest X-ray findings
suggestive of aortic dissection.
⫸ A 72-year-old male presents with five hours of substernal chest pain
and pressure despite taking three sublingual nitroglycerin. You order an
EKG. What findings on the EKG would indicate that this patient is
potentially a candidate for thrombolytic therapy?
A. Ventricular tachycardia
B. ST-segment elevation of at least 1 mm in two or more contiguous
leads
C. ST-segment depression of at least 2mm in any precordial lead
D. Atrial fibrillation with a rapid ventricular response Answer: The
answer is B. "Fibrinolytic therapy is indicated for patients with STEMI
(as a reperfusion option) if time to treatment is <6 to 12 hours from
symptom onset, and the ECG has at least 1-mm ST-segment elevation in
two or more contiguous leads."
FEMALE CHEST PAIN I-HUMAN CASE
STUDY PRACTICE SCRIPT UPDATED 2026
TESTED SOLUTIONS
⫸ A 70 year old woman presents with chest pain that began 2 hours
ago. She describes it as substernal radiating to her jaw and left shoulder;
there is no other area of pain or radiation. She took an aspirin at home
but the pain is not better. She also took 3 sublingual nitroglycerin tablets
en route to the hospital. Her initial EKG shows ST elevation in the
anterior leads >2mm and ST depression in the inferior leads. The nurse
has already administered oxygen, placed her on an EKG monitor, and
attained IV access. You order beta-blockade and nitroglycerin for pain
relief, and the supervising resident asks you which of the following
should be done next:
A. Call her primary care physician.
B. Send her to radiology for a good-quality chest X-ray.
C. Give her a GI cocktail to check for pain relief from this.
D. Call cardiology for a decision between thrombolytic and
percutaneous coronary intervention.
E. Call cardiology Answer: The answer is D. This patient is having an
acute myocardial infarction. AMI is defined when two of the following
three findings are present: clinical history of chest pain of at least 20
minutes duration, EKG changes and/or positive myocardial enzyme
testing. This patient has ST elevation with concomitant ST depression in
contiguous leads with chest pain. She needs immediate thrombolytic
therapy or cardiac catheterization; if percutaneous coronary intervention
, (PCI) can be achieved within 90-120 minutes of emergency department
arrival, the literature supports its selection over thrombolytic therapy as
primary intervention. In preparation for either thrombolytic therapy or
PCI, you need to control her pain, maximize O2 delivery, decrease work
of the heart and inhibit platelet function. O2, nitroglycerin and morphine
will increase O2 delivery to the heart. A beta blocker, which should also
be administered to AMI patients who lack contraindications, will
decrease the work of the heart, and aspirin will inhibit platelets. A
glycoprotein IIb/IIIa-inhibitor should also be administered - selections
will depend on the exact treatment course chosen for the patient.
Anticoagulation with low molecular weight heparin or unfractionated
heparin (dose being dependent on exact treatment course for patient)
should be started if there are no patient historical or chest X-ray findings
suggestive of aortic dissection.
⫸ A 72-year-old male presents with five hours of substernal chest pain
and pressure despite taking three sublingual nitroglycerin. You order an
EKG. What findings on the EKG would indicate that this patient is
potentially a candidate for thrombolytic therapy?
A. Ventricular tachycardia
B. ST-segment elevation of at least 1 mm in two or more contiguous
leads
C. ST-segment depression of at least 2mm in any precordial lead
D. Atrial fibrillation with a rapid ventricular response Answer: The
answer is B. "Fibrinolytic therapy is indicated for patients with STEMI
(as a reperfusion option) if time to treatment is <6 to 12 hours from
symptom onset, and the ECG has at least 1-mm ST-segment elevation in
two or more contiguous leads."
