Throat, Respiratory and Cardiovascular Disorders Case 3

Sample Answer

The case study presents a 75-year-old female who reported chest pain during stair climbing today. She had experienced insomnia the previous night. The individual experiences discomfort or a burning feeling in the middle of the sternum. This discussion presents supplementary subjective and objective data, potential diagnoses, and alternative possibilities.

Question 1 Additional Subjective data

Additional subjective data to gather from the patient includes the duration of the pain, the nature of its onset (sudden or gradual), any radiation of pain to other areas, and factors that worsen or relieve the pain. In her family history, I would inquire about cardiovascular disease, myocardial infarctions, or stroke. These questions aid in directing the physical examination process, facilitating the accurate determination of the underlying cause of chest pain (Beck et al., 2021).

Question 2 Additional Objective Data

I would evaluate her capillary refill, as a delayed refill may indicate cardiovascular dysfunction. Additionally, I would assess the temperature of her skin, as cold skin could suggest circulatory issues. I would conduct a comprehensive assessment of all pulses to ensure bilateral equality. Additionally, it is essential to evaluate for jugular venous distention (JVD) as it indicates right ventricular failure, a condition that is suspected in the patient (Beck et al., 2021).

Question 3 Diagnostic exams to order

The ECG records the resting electrical activity of the heart. The electrocardiogram (ECG) provides information about heart rate, rhythm, and potential cardiac enlargement. The primary indicators are ST-segment elevation or depression, T-wave inversion, and dysrhythmias (Beck et al., 2021).

An echocardiogram is a diagnostic procedure that assesses the functioning of the heart’s chambers and valves regarding blood circulation. Additionally, it sets the ejection fraction, a metric that quantifies the proportion of blood expelled from the heart during each contraction, aiding in the differentiation of heart failure.

24-hour electrocardiogram (ECG) monitoring, or Holter monitoring, is conducted to assess the correlation between pain episodes and their alteration during exercise or physical activity.

A stress test or stress echo can indicate the duration and intensity of physical exertion preceding the onset of chest pain.

The blood tests conducted include a complete blood count (CBC), comprehensive metabolic panel (CMP), serum lipid profile, creatine phosphokinase (CPK), creatine kinase (CK), creatine kinase-MB (CK-MB), troponin, and brain natriuretic peptide (BNP).

A chest x-ray can detect cardiac decompensation or pulmonary complications.

Cardiac catheterization with angiography is considered the definitive test for coronary artery disease (CAD) as it allows for visualizing arterial blockages (Beck et al., 2021).

Endoscopy is performed to exclude gastroesophageal reflux disease (GERD).

Question 4. Differential diagnoses with rationales.

Angina Pectoris

Pectoral chest pain occurs when there is insufficient coronary blood flow to adequately supply a portion of the heart (Beck et al., 2021). Consequently, the myocardium receives less oxygen due to stress or physical effort. With sensations of tightness or squeezing in your chest that might spread to the shoulders, arms, and neck, it can often feel just like a heart attack.

GERD

Heartburn, which may feel like a searing ache in your chest that begins under your breastbone and spreads up to your neck and throat, is the most typical symptom of GERD. GERD discomfort is often misdiagnosed as a heart attack or cardiac illness (Katz et al., 2021). GERD is brought on by painful stomach acid reflux into the esophagus. This discomfort might be experienced as a sharp pain or a burning feeling behind the sternum or breastbone.

Anxiety/Panic Attack

Panic attack symptoms might resemble heart attack symptoms. The symptoms of a heart attack are often experienced by those with panic episodes (Nault Connors et al., 2022). Both diseases result in a racing or pounding heart, chest pain, shortness of breath, sweat, and lightheadedness. A significant difference between the two is that although panic attacks may happen when you’re at rest, heart attacks often start during times of exercise, like working in the yard. Another distinction is that, unlike heart attacks, which often worsen over time, panic attacks typically go away on their own in about 20 minutes.

References

• Beck, S., Martínez Pereyra, V., Seitz, A., McChord, J., Hubert, A., Bekeredjian, R., Sechtem, U., & Ong, P. (2021). Invasive Diagnosis of Coronary Functional Disorders Causing Angina Pectoris. European Cardiology Review, 16. https //doi.org/10.15420/ecr.2021.06
• Katz, P. O., Dunbar, K. B., Schnoll-Sussman, F. H., Greer, K. B., Yadlapati, R., & Spechler, S. J. (2021). ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. American Journal of Gastroenterology, Publish Ahead of Print(1). https //doi.org/10.14309/ajg.0000000000001538
• Nault Connors, J. D., Kroenke, K., Monahan, P. O., Chernyak, Y., Pettit, K., Hayden, J., Montgomery, C., Brenner, G., Millard, M., Holmes, E., & Musey, P. (2022, August 16). Comparing the Effectiveness of Existing Anxiety Treatment Options Among Patients Evaluated for Chest Pain and Anxiety in the Emergency Department Setting Study Protocol for the PACER Pragmatic Randomized Comparative Effectiveness Trial. Social Science Research Network. https //doi.org/10.2139/ssrn.4191729