A 66-year-old, 70-kg woman with a history of MI, HTN, hyperlipidemia,
A 66-year-old, 70-kg woman with a history of MI, HTN, hyperlipidemia, and diabetes mellitus presents with
sudden-onset diaphoresis, nausea, vomiting, and dyspnea, followed by a bandlike upper chest pain (8/10) radiating to her left arm.
She had felt well until 1 month ago, when she noticed her typical angina was occurring with less exertion.
Electrocardiography showed ST-segment depression in leads II, III, and aVF and hyperdynamic T waves and positive cardiac enzymes. BP = 150/90 mm Hg, and all labs are normal; SCr =1.2 mg/dL. Home medications are aspirin 81 mg/day, simvastatin 40 mg every night, metoprolol 50 mg twice daily, and metformin 1 g twice daily
What do you think is going on with this patient?
What type of treatment will you recommend?