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Present Illness<br>This 55-year-old man has the history of hyperlipidemia, hypertension and diabe-<br>tes for several years and was under irregular medication control at the clinic. Two days<br>prior to admission, he experienced sudden-onset of chest pain and intermittent sub-<br>stermal chest tightness. The pain radiated to left shoulder and the middle back area. The<br>duration of chest pain lasted about 15 minutes. He also had severe shortness of breath<br>and cough while lying down. According to the patient, he actually bad orthopnea, par-<br>oxysmal nocturnal dyspnea, dyspnea on exertion and lowver leg edema for around one<br>week. The dyspnea got worse over the past 2 days so he was sent to our ER, At ER, his<br>laboratory results showed elevated cardiac enzymes. Chest plain film revealed pulmo-<br>nary edema and left pleural effusion. Electrocardiogram showed diftused ischemic<br>changes. Under the impression of NSTEMI, he was admitted for further treatment.
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