Tag: Chest Pain

Chest Pain

Posted on | by Brian Leakey

CP is a 64-year-old male who presents to the emergency department (ED) via ambulance for chest pain. He was out shoveling snow from his driveway when he developed left anterior chest pain, pressure-type, radiating to his jaw and shoulder. Despite the cold weather, he was sweating. He also noted palpitations and shortness of breath, although he thought it was just because he was “a little out of shape.” He was afraid that something was wrong, so he asked his wife to call 911.
Past Medical History
• Hypertension
• Hyperlipidemia
• Diabetes mellitus
• Gout Medications
• Hydrochlorothiazide, 25 mg once daily
• Allopurinol, 300 mg once daily
Social History
• Retired factory worker
• Smokes one pack of cigarettes per day
• Drinks about six beers per day (sometimes more)
Physical Examination
• Well-developed obese man in moderate distress
• Height: 69 inches; weight: 252 lbs.; blood pressure: 172/110; pulse: 92; respiration rate: 16; temperature: 98.7 °F
• Lungs: Scattered bilateral wheezes
• Heart: Regular with grade II/VI systolic murmur
• Extremities: No edema
Labs and Imaging
• Complete blood count with mild leukocytosis (WBC 12.9k)
• Potassium: Low at 2.9 mEq/L
• Glucose: 252 mg/dL
• Troponin I: 1.7 ng/L
• Uric acid: 11.1 mg/dL
• EKG: ST segment depression with T-wave inversion over lateral leads; no pathologic Q waves Next Steps
• CP’s admitting diagnoses are non-ST segment elevation acute coronary syndrome, hypertension, diabetes mellitus, obesity, alcohol abuse, hyperuricemia, and smoker
Discussion Questions

  1. What medications should be instituted for CP?
  2. What medications should be continued after discharge?
  3. What lifestyle modifications can be recommended for CP?

Chest Pain

Posted on | by Brian Leakey

A 52-year-old male patient who is a house painter presents to the office reporting chronic fatigue and “mild” chest pain. When he is painting, chest pain is relieved after taking a break. He reports that the pain usually lasts 5 minutes or less and occasionally spreads to his left arm before subsiding. The patient was last seen 3 years ago by you, and you recommended diet changes to manage mild hyperlipidemia, but the patient has gained 30 pounds since that time. The patient’s medical history includes anxiety, vasectomy, cholecystectomy, and mild hyperlipidemia. The patient does not smoke or use other tobacco or nicotine products. The patient cares for his wife, who has multiple sclerosis and requires 24-hour care. His daughter and grandson also live with the patient. His daughter assists with the care of his wife, and his job is the major source of income for the family. The initial vital signs are: blood pressure 158/78, heart rate 87, respiratory rate 20, and body mass index 32. As part of the diagnostic work-up, an ECG, lipid levels, cardiac enzymes, and C-reactive protein (CRP) are ordered. The patient reports that he does not have time to “be sick” and says that he needs to take care of everything during this visit so he can return to work and care for his wife. Discuss the following:

What additional information should you obtain about the pain the patient is experiencing?
What additional physical assessment needs to be performed with this patient?
What considerations are important to remember if the patient’s CRP level is elevated?
What differential diagnoses should be considered for the patient?
What patient teaching will be incorporated into the visit to modify the patient’s risk factors?
How will you respond to the patient’s statement that he does not have time to “be sick” and needs to take care of everything during this visit?
Post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

Chest Pain

Posted on | by admin3

 

 

CP is a 64-year-old male who presents to the emergency department (ED) via ambulance for chest pain. He was out shoveling snow from his driveway when he developed left anterior chest pain, pressure-type, radiating to his jaw and shoulder. Despite the cold weather, he was sweating. He also noted palpitations and shortness of breath, although he thought it was just because he was “a little out of shape.” He was afraid that something was wrong, so he asked his wife to call 911.
Past Medical History
• Hypertension
• Hyperlipidemia
• Diabetes mellitus
• Gout Medications
• Hydrochlorothiazide, 25 mg once daily
• Allopurinol, 300 mg once daily
Social History
• Retired factory worker
• Smokes one pack of cigarettes per day
• Drinks about six beers per day (sometimes more)
Physical Examination
• Well-developed obese man in moderate distress
• Height: 69 inches; weight: 252 lbs.; blood pressure: 172/110; pulse: 92; respiration rate: 16; temperature: 98.7 °F
• Lungs: Scattered bilateral wheezes
• Heart: Regular with grade II/VI systolic murmur
• Extremities: No edema
Labs and Imaging
• Complete blood count with mild leukocytosis (WBC 12.9k)
• Potassium: Low at 2.9 mEq/L
• Glucose: 252 mg/dL
• Troponin I: 1.7 ng/L
• Uric acid: 11.1 mg/dL
• EKG: ST segment depression with T-wave inversion over lateral leads; no pathologic Q waves Next Steps
• CP’s admitting diagnoses are non-ST segment elevation acute coronary syndrome, hypertension, diabetes mellitus, obesity, alcohol abuse, hyperuricemia, and smoker
Discussion Questions
1. What medications should be instituted for CP?
2. What medications should be continued after discharge?
3. What lifestyle modifications can be recommended for CP?