Chest Pain\Lasting 10 Hours\Nitroglycerin\Difficult to Obtain\Chest Pain Resolved

Male, 67 years old Admitted to the emergency department for gastrointestinal bleeding. Tranexamic acid was administered for hemostasis during the emergency visit. Chest pain began on the morning of the 19th. The following are excerpts from the medical records.

Blood routine report Department: Emergency Internal Medicine Sample type: Whole blood Clinical diagnosis: Chest pain Report time: November 19, 21:50 1. White blood cell count 16.04 (3.50-9.50 * 10⁹/L) 2. Neutrophil percentage 80.60% (40.00-75.00%) 3. Lymphocyte percentage 14.10% (20.00-50.00%) 4. Monocyte percentage 3.20% (3.00-10.00%) 5. Eosinophil percentage 1.90% (0.40-8.00%) 6. Basophil percentage 0.20% (0.00-1.00%) 7. Neutrophils 12.93 (1.80-6.30 * 10⁹/L) 8. Lymphocytes 2.26 (1.10-3.20 * 10⁹/L) 9. Monocytes 0.51 (0.10-0.60 * 10⁹/L) 10. Eosinophils 0.30 (0.02-0.52 * 10⁹/L) 11. Basophils 0.03 (0.00-0.06 * 10⁹/L) 12. Red blood cell count 2.23 (4.30-5.80 * 10¹² /L) 13. Hemoglobin 65 (130-175g/L) 14. Hematocrit 0.208 (0.400-0.500L/L) 15. Mean corpuscular volume 93.3 (82.0-100.0fl) 16. Mean corpuscular hemoglobin 29.1 (27.0-34.0pg) 17. Mean corpuscular hemoglobin concentration 313 (315-365g/L) 18. Red cell distribution width 0.14 (0.110-0.145) 19. Platelet count 363 (125-350 * 10⁹/L) 20. Plateletcrit 0.40 (0.100-0.350) 21. Platelet distribution width 12.3 (9.0-18.1fl) 22. Mean platelet volume 11.0 (6.5-11.5fl) 23. Large platelet ratio 34% (13-43%) 24. High-sensitivity C-reactive protein 28 (0-10mg/L) 25. Serum amyloid A 72 (0-10mg/L)

Electrocardiogram (November 19, 21:17) report written by hand; handwriting difficult to read, possibly indicating 1. Abnormal Q waves with ST-segment elevation 2. ST-segment changes (I, aVL, II, III flat or inverted)

Department: Emergency Internal Medicine Sample type: Plasma Clinical diagnosis: Upper gastrointestinal bleeding Report time: November 20, 00:46 1. Total bilirubin 6 (3-28μmol/L) 2. Alanine aminotransferase 27 (0-50U/L) 3. Aspartate aminotransferase 33 (0-50U/L) 4. AST/ALT 1.22 5. γ-Glutamyl transferase 25 (0-52U/L) 6. Lactate dehydrogenase 380 (313-618U/L) 7. Creatine kinase 221 (24-195U/L) 8. Creatine kinase isoenzyme 53 (0-25U/L) 9. Cardiac troponin T 0.224 (0-0.014ng/mL)

By around 9 p.m., the chest pain had persisted for hours and the family could no longer tolerate the situation, so they contacted the author. After reviewing the patient’s real-time video, electrocardiogram, and other records, the author recommended nitroglycerin. The doctor warned of serious side effects and required the family to sign a consent form. After the family signed, the doctor prescribed one tablet of nitroglycerin. When the family asked whether more tablets could be prescribed, the doctor replied that the pharmacy had only 10 tablets in stock and needed to reserve them for other patients. The patient took one tablet and the chest pain resolved quickly.