Health History
Female patient c/o CP. “Worried about sharp chest pains for the past 2 weeks”. Reports sharp pain on L chest x2 weeks ago, sweating, SOB x5 mins., heart racing. States current level of pain is 5 out of 10. Is not radiating. 2 other episodes of x10 days ago when lifting books and 5 days ago when discussing father’s death. Experienced sweating, SOB, lightheaded, pain was 5/10 x5 mins. and went away. Today patient reports feeling fine, and hasn’t been sleeping well. States does not have any stomach problems, does not exercise. Had high BP during pregnancy. Ex smoker in her 20s. Drinks 3 glasses of ETOH 3=5 x a wee. Family history + for CVD; mother died of MI at 62. Brother had CABG at 42.
Physical Exam
BP 150/95 HR 95
1. What findings might be important to look for as you observe this patient? When inspecting the patient, it is important to observe breathing pattern, facial expression that may indicate pain or distress, respiratory rate, and assess skin color.
2. What possible causes of CP are you considering? At this time, patient seems to be having anxiety and distress due to recent loss of family. Distress, angina, GERD, and possibly fibromyalgia.
3. What cardiovascular risk factors do you need to consider in this patient? and which one has the highest risk for CAD? Risk factors for this patient include obsesity, age, sedentary lifestyle, history of CAD in family, HLD, HTN, smoking, DM, and anxiety.
4. The following findings may be heard in the cardiac auscultation of this patient. Can you identify this heart sound? S4 heart sound is heard.
5. Identify this heart sound heard in the mitral area or apex. Mitral regurgitation murmur is heard.
6. Which findings on the cardiac exam have the best evidence for CHF? S3 heart sound, crackles, elevated JVP, and JV
7. D are all signs of CHF.
8. Identify this extra heart sound. S3 is heard.
Diagnostic Considerations
Patient may be diagnosed with angina, anxiety, panic attack, stress, GERD. Angina may be related to patient’s anxiety level. Panic attack related to symptoms of anxiety, sweating. GERD may be related to alcohol consumption.
Diagnostic Workup
Patient will need a CXR for Assessment, ECHO, BNP, Trop., EKG for ST Assessment, stress test, and a psychiatric Assessment.
Stress related myocardial infarction is a common and frequent occurrence in patients with coronary artery disease; women with CAD usually have more stress–induced MIs and more chest pain symptoms than men (Pimple et al., 2018). MIs related to stress and caused by stress are a real phenomenon in women. According to this study by Pimple et al. (2018), Women with stable CAD report more CP/angina than men. Stress prevention and anxiety management in women may be key to preventing angina and MIs. CP in women is often a symptom that may be a precursor to an MI or CVD; understanding psychological stress makes for a positive outcome and management of angina in women (Pimple et al., 2018). In this week’s case study, the patient had anxiety, stress, and panic attack related to the passing of her father. This kind of stress will lead to CP and possible MI. Managing these symptoms are essential in preventing a heart attack since she has a strong family history of CVD. Managing these symptoms will also make for positive outcomes.

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