A 65-year-old male patient with a history of coronary artery disease (bypass grafting 10 years ago), diabetes mellitus, hyperlipidemia, and peripheral vascular disease experienced persistent substernal gripping chest pain and was evaluated in the local emergency room. He was found to be pale and diaphoretic, with runs of nonsustained VT. He was started on intravenous nitroglycerin, heparin, and eptifibatide, and transferred to our facility for suspected acute coronary syndrome. His cardiac enzymes showed a creatine kinase (CK) of 171 u/1 (39-195 u/1), CK MB fraction of 3.2 u/1 (0.0-5.0 u/1), and troponin T of 0.01 ng/ml (0.0-0.1 ng/ml). His serum creatinine was 2.1 mg/dl (0.5-1.4 mg/dl), drug sodium 135 meq/1 (135-145 meq/1), potassium 4.1 meq/1 (3.5-5.0 meq/1), magnesium 2.3 mg/dl (1.7-2.5 mg/dl), generic calcium 9.0 mg/dl (8.5-10.2 mg/dl), and albumin 3.3 g/dl (3.5-5.0 g/dl). Echocardiogram showed mildly dilated left atrium, dilated left ventricle with posterior hypokinesis, and an ejection fraction of 40%.
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