Unstable Angina with underlying Ischemic Heart Disease

70 year old Malay Male known case of Ischemic Heart Disease and a smoker (40pack years) presented to the hospital due to crushing chest pain for 11days prior to admission and was associated with profuse sweating and nausea.
The pain, on admission, occurred when patient was at rest with a pain score of 5/10. Pain was worst on exertion and relieved by rest. There was no radiation, leg swelling, palpitation or shortness of breath. Nothing significant was noted on admission at the emergency department. All vital signs were within normal ranges.
At the Emergency Department, patient's ECG showed T depression in Leads I, II, aVL, aVF, V4-V6. Cardiac enzymes however were not raised.
The patient was started on:
1.T. Aspirin 150mg OD
2.T. Plavix 75mg OD
3.S/L GTN 1/1 PRN
4. T. ISMN 30mg  OD
5. IV Ranitidine 50mg TDS
6. T.Simvastatin 20mg ON
Patient was encouraged to take complete blood rest. ECG was to be done on chest pain.

Day 2 of admission
Patient had no active complaints. He was able to tolerate orally and sleep well.  Physical examination has nothing significant to note. Renal profile showed normal values. ECG showed T-depression on lead I, II, aVL, V4-V6. Patient was started on S/C Fondaparinux 2.5mg OD for 3days. He was also started on T. Lasix 20mg OD. (Unsure why Lasix was started)

Day 3 of admission
Patient was asymptomatic. He was on day 2 of s/c Fondaparinux 2.5mg. All vitals were within normal ranges except his blood pressure was raised. He was able to tolerate orally and sleep well. Physical examination was unremarkable. ECG showed T-depression in Leads I, II, V3-V6. Previous management plans were continued. Patient was started on T. Perindopril 2mg OD. ECHO was planned for the patient as an outpatient.

Day 4 of admission
Patient was asymptomatic. He complained of hearing loss. He was on day 3 of S/C Fondaparinux 2.5mg. All vitals were within normal ranges. Physical examination was unsignificant. He was planned for discharge once the s/s Fondaparinux was given. Patient was discharged with:
1. T.Simvastatin 20mg ON
2. T. ASA 150mg OD
3. T.ISMN 30mg OD
4. s/l GTN 1/1 PRN
Patient was referred to ENT as an outpatient. He was given TCA at the MOPD in 3 months with ECHO, RP and FBC.
He was counselled on the importance of complicance to his medications and the possible complications. Patient understood. Upon discharge, patient was comfortable and no longer had any signs and symptoms.