I HUMAN CASE WEEK #4 69 YEAR OLD REASON FOR ENCOUNTER:CHEST PAIN (CLASS 6531), Exams of Health sciences

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I HUMAN CASE WEEK #4 69 YEAR OLD REASON FOR ENCOUNTER:CHEST PAIN (CLASS 6531)LOCATION ;OUTPATIENT CLINIC WITH X-RAY,ECG,AND LABARATORY CAPABILITIES.LATEST CASE 2024 Patient Information: • Age: 69 years old • Height: 5’3” (160 cm) • Weight: 167.0 lb (75.9 kg) • Reason for Encounter: Chest pain • Location: Outpatient clinic with x-ray, ECG, and laboratory capabilities. 1of2 Index of Exercises If you were thinking of acute coronary syndrome, and he told you he had been having chest pressure after walking two blocks briskly for the past month, this diagnostic hypothesis would become O Much less likely O Less likely O Neither more nor less likely O More likely © Much more likely correct, found- TO Less likely correct, found- -P.E BP: 130/ 84, laying Pulse: 88 RR: 16 1of2 Index of Exercises If you were thinking of aortic dissection, and then you were to find that his measured systolic blood pressures in both arms differed by 30mm Hg, this diagnostic hypothesis would become O Much less likely O Less likely O Neither more nor less likely © More likely O Much more likely correct, found- use of his chest pain and shortness of is left base, this diagnostic hypothesis would. correct, found-  :Problem Statement J.A. is a 58 y/o male presenting with a burning chest discomfort. Rating pain 4-5/10, with pain that radiates into the neck (around the Adam's apple), lasting 30 minutes. Denies taking medication for discomfort, denies medical hx. Confirms poor eating habits, obesity, alcohol use 3 drinks/wk, and lack of .exercise :Madalyn ee eg Se ey re ag ee te (Must Not Miss). DDx Rank Differential Diagnosis O Lead © Alt MNM _ achalasia © Lead © Alt MAMNM coronary artery disease (CAD) © Lead © Alt [] MNM _ dyspepsia, functional © Lead © Alt OMNI | gastritis © Lead O Alt [JMNM - gastroesophageal reflux disease (GERD) © Lead © Alt CJ MNN | gastroparesis © Lead © Alt [J] MNN _ternia, hiatal © Lead © Alt TJ) MNN pancreatitis, chronic O Lead © Alt MNM peptic ulcer disease (PUD) :Madalyn “TestiDifferential Association acute coronary syndrome _ 12 lead electrocardiogram (ECG) troponin | (cTnl) troponin T (cTnT) aortic dissection CT aortogram echocardiogram, transesophageal (TEE) dyspepsia, functional Helicobacter pylori antibodies Helicobacter pylori stool antigen (HpSAg) endoscopy gastritis ie i} put  barium swallow, cardiac catheterization, cardiac stress test, CBC, CMP, coronary angiogram cath, ) endoscopy, H pylori antibiodies, H pylori stool antigen, stomach biopsy, and pancreas biopsy not (recommended Do not smoke, do not lie down immediately after meals, elevate the HOB when laying down :Medications Antacids: Tums - Pepcid - PPIs: Prilosec, Nexium, Protonix Reglan - :If pain persists Endoscopy, pH testing, and/or esophageal manometry may be done - I put: “more likely” for question 9/12 Correct, found - Correct, found - History: • Chief Complaint: The patient presents with chest pain. • History of Present Illness (HPI): o Onset: When did the chest pain start? o Location: Where is the chest pain located? (e.g., central, left- sided, radiating to the arm) o Duration: How long has the chest pain lasted? o Quality: Describe the nature of the chest pain (e.g., sharp, dull, pressure-like, squeezing). o Severity: How severe is the pain on a scale of 1-10? o Timing: Is the pain continuous or intermittent? o Aggravating/Alleviating factors: What makes the pain worse (e.g., exertion, eating) or better (e.g., rest, medications)? o Gastroesophageal Reflux Disease (GERD) (Burning chest pain related to meals or lying down). o Pulmonary Embolism (Sharp chest pain, particularly if there’s sudden onset and respiratory symptoms). o Costochondritis (Chest wall tenderness without cardiac or respiratory findings). Tests: • Electrocardiogram (ECG): o Assess for ST-segment changes, T-wave inversions, or arrhythmias that might indicate ischemia or infarction. • Chest X-ray: o Evaluate for cardiomegaly, pulmonary edema, or other pulmonary causes of chest pain. • Laboratory Tests: o Troponin levels: To rule out myocardial infarction. o Complete blood count (CBC): To rule out infection. o D-dimer: If pulmonary embolism is suspected. o Basic metabolic panel (BMP): To check electrolyte levels and kidney function, especially before starting medications. o Lipid profile: To evaluate cardiovascular risk factors. • Stress Test: If the ECG is inconclusive and there’s a suspicion of coronary artery disease. • Echocardiogram: To assess heart function and rule out any structural abnormalities. Diagnosis: • Probable Diagnosis: Angina Pectoris (stable or unstable) based on the chest pain presentation and cardiovascular risk factors. • Secondary Diagnosis: GERD or costochondritis, depending on further clinical findings and test results. Plan: 1. Medications: o Nitroglycerin: Sublingual for immediate chest pain relief if angina is suspected. o Aspirin: If myocardial infarction is suspected, administer 325 mg. o Beta-blocker: To reduce heart workload and control blood pressure. o Proton Pump Inhibitor (PPI): If GERD is suspected. 2. Monitoring: o Continuous ECG monitoring if the patient is unstable or if acute coronary syndrome is suspected. 3. Lifestyle Changes: o Smoking cessation, low-fat diet, regular physical activity. o Educate the patient on recognizing warning signs of heart attacks and when to seek emergency care. 4. Follow-Up: o Schedule a cardiology referral for further workup if angina or coronary artery disease is suspected. o Follow-up in 1 week or earlier if symptoms worsen or new symptoms develop. Summary: A 69-year-old male presents with chest pain. The primary diagnosis is suspected angina pectoris based on the patient’s age and potential cardiovascular risk factors. Immediate treatment includes nitroglycerin for pain relief and further evaluation with ECG, lab tests, and chest x-ray. The plan includes close monitoring for myocardial infarction and lifestyle modifications to address risk factors like hypertension and cholesterol. This structured approach ensures a thorough evaluation and management plan for the patient's presenting complaint of chest pain.