For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases.
Chief complain: A 75-year-old female reports experiencing pain in her chest while walking up steps today.
Subjetive: Could not sleep previous night. Feels like an ache or a burning sensation at the center of sternum. Denies any arm pain, pain was at a scale of 8 in the AM now it is at a 2. Suffers from History of hypertension, denies heart disease, denies leg swelling up, denies pain feeling worse when taking deep breath.
VS: BP 129/70, (HR) 72 and regular, (RR) 16 unlabored, temperature 98.8°F, oral pulse oximetry is 99%
General: obese female, alert, in no acute distress.
HEENTAtraumatic, normocephalic, PERRLA, EOMI, sclera with mild icterus, nares patent, nasopharynx clear, poor dentition – multiple carries.
Respiratorio: CTA AP&L
Neck: carotids are 2+ without bruits; thyroid is not palpable; no lymphadenopathy
Heart: S1 and S2 normal without murmur, gallop, or rub
Once you received your case number, answer the following questions:
1. What other subjective data would you obtain?
2. What other objective findings would you look for?
3. What diagnostic exams do you want to order?
4. Name 3 differential diagnoses based on this patient presenting symptoms?
5. Give rationales for your each differential diagnosis.
Submission Instructions:
• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 3 academic sources.
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Some subjective data that I would obtain from this patient would include the duration of the chest pain, any associated symptoms such as nausea, vomiting, or shortness of breath, any previous episodes of chest pain, and any family history of heart disease. I would also ask the patient about her current medications and any allergies or adverse reactions she may have had to medication in the past.
More objective findings that I would look for include signs of peripheral edema, such as swelling in the legs or feet, as well as any signs of cyanosis, such as blue discoloration of the skin or lips. I would also assess the patient’s lung sounds for any wheezing, crackles, or rales, and check for any peripheral pulses, such as the radial or dorsalis pedis pulse.
Some diagnostic exams that I would order for this patient would include an electrocardiogram (ECG) to evaluate for any cardiac abnormalities, a chest x-ray to evaluate for any lung or pleural disease, and a cardiac biomarker panel, such as troponin, to evaluate for any cardiac injury. Depending on the results of these initial tests, additional diagnostic exams such as a CT angiogram or echocardiogram may be considered.
Three differential diagnoses based on this patient’s presenting symptoms would include:
Acute coronary syndrome (ACS): This diagnosis would be considered based on the patient’s presentation of chest pain, which is described as an ache or burning sensation at the center of the sternum. ACS includes a spectrum of conditions caused by reduced blood flow to the heart, including unstable angina, non-ST segment elevation myocardial infarction (NSTEMI), and ST segment elevation myocardial infarction (STEMI).
Pulmonary embolism (PE): This diagnosis would be considered based on the patient’s presentation of chest pain, which may be described as sharp or stabbing, and shortness of breath. PE is a blockage in the pulmonary artery caused by a clot that travels from elsewhere in the body, usually the legs.
Gastroesophageal reflux disease (GERD): This diagnosis would be considered based on the patient’s presentation of chest pain, which may be described as a burning sensation and associated with episodes of heartburn. GERD is a common condition in which acid from the stomach flows back into the esophagus, causing irritation and pain.
Rationale for each differential diagnosis:
Acute coronary syndrome: The patient’s presentation of chest pain, described as an ache or burning sensation at the center of the sternum, and her history of hypertension are consistent with ACS. Additionally, the patient’s age, being 75, increases her risk for heart disease.
Pulmonary embolism: The patient’s presentation of chest pain, which may be described as sharp or stabbing, and shortness of breath, and her recent lack of sleep are consistent with PE. Additionally, the patient’s age, being 75, increases her risk for blood clots.
Gastroesophageal reflux disease: The patient’s presentation of chest pain, which may be described as a burning sensation, and her recent lack of sleep are consistent with GERD. Additionally, the patient’s age, being 75, increases her risk for GERD.
