List seven laboratory or diagnostic tests you would expect to be performed; suggest what each might contribute
And what other sources, in addition to cardiac ischemia, might be responsible for her chest and abdominal discomfort?
• Twelve-lead electrocardiogram (ECG): To determine whether R.K. has had a prior MI, whether she
is showing ischemic changes and in what part of her heart, and whether she is having irregular
rhythms. (ECG is not an exclusive test for MI.)
• Chest x-ray (CXR): To see whether the heart (cardiac silhouette) is enlarged or whether there might
be any visible structural problems or defects that are contributing to her symptoms. Check for
pulmonary edema.
• Oxygen saturation: To determine whether her symptoms might be related to a respiratory disorder
or whether her heart is able to adequately pump blood through her lungs.
• Cardiac enzymes: Creatine phosphokinase with isoenzymes if elevated and troponin T or I to
determine whether she has had an MI.
• Complete blood count (CBC) with differential: To check for anemia or infection.
• D-dimer test to rule out pulmonary embolus.
• Metabolic or chemistry panel, or acute care panel, including serum lipid panel urinalysis (UA).
• Prothrombin time/international normalized ratio (PT/INR) and partial thromboplastin time (PTT):
To examine for basic coagulation disorders.
Gastrointestinal: indigestion, gastritis, hiatal hernia, reflux esophagitis, gastroesophageal reflux
disease (GERD), gallbladder disease, esophageal spasm, peptic ulcer disease (PUD)
Respiratory: pleurisy, pulmonary embolism, pneumonia, pneumothorax
Cardiac: vasospastic angina, mitral valve prolapse (MVP), severe aortic stenosis, cardiac dysrhythmia,
pericarditis
Musculoskeletal: rib fracture, costochondritis, respiratory muscle strain, vertebral fractures or
compression resulting in nerve impingement
Metabolic: anemia, carbon monoxide toxicity
Psychosocial: anxiety or stress, panic attack
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