Acute coronary syndrome is a typical life-threatening condition. Nevertheless, 1-8% of patients rushed to the emergency outpatient unit are sent home. One of the reasons for that is the absence of pain in a minority of myocardial infarction cases. It is said that 25% of the patients with acute coronary syndrome visit hospitals without complaining of chest pain, and about 1% of the patients complaining of nausea and vomiting only. In this paper, we present a case diagnosed as anteroseptal myocardial infarction at the outpatient department of internal medicine. The patient had symptoms of queasy feeling and vomiting. Coronary artery bypass grafting was indicated. We examined the case, focusing on the diagnostics with bibliographical consideration. Acute coronary syndrome cannot be ruled out in the elderly, even if they have fewer risk factors. In cases like the present one, when no other accessory symptoms are noted, the condition should be considered in the differential diagnosis. We believe that this will prevent life-threatening acute coronary syndrome from being overlooked.

Patients with heart failure often have difficulty in stopping cardiotonic drugs as the disease stage progresses, and long-term hospitalization is a factor that significantly reduces quality of life. To solve this problem, in September 2017, our hospital started an initiative to support overnight stays at home by using a portable precision infusion pump and continuously injecting cardiotonic drugs with the approval of the hospital’s medical ethics committee. Since there are few case reports of similar efforts in Japan, here we describe the use of drugs and the content of the intervention by pharmacists. The drug is administered via a peripherally inserted central venous catheter using an ambulatory precision infusion pump. The pharmacist calculates the drug dose and flow rate required during the at-home period using spreadsheet software, and proposes a prescription to the doctor. In addition, if multiple cardiotonics and diuretics are administered, the presence or absence of compounding changes is confirmed, and the feasibility of mixing should be examined, and then prepared aseptically on a clean bench on the day of administration. We started to administer catecholamine while in the hospital on the day before the stay at home. Then we prepared the catecholamine in a portable precision infusion pump and administered it during stay at home. To date, we have supported 8 cases in stays at home without emergency hospitalization or sudden death due to exacerbation of heart failure.