Chest Pain Differential Diagnosis Case Study
You studied the cardiovascular system in your readings last week. This week you completed a focused assessment of Brian Foster, a patient who is assessed for chest pain.
Please share your analysis of the subjective & objective data you collected during your assessment and provide your differential diagnoses, describing the clinical reasoning that helped you choose your diagnoses.
Share your individualized care plan for Brian and include any lifespan or developmental considerations and cultural needs for this patient.
- subjective data: Pt. reports: “I have been having some troubling chest pain in my chest now and then for the past month.” Experiencing periodic chest pain with exertion such as yard work, as well as with overeating. Points to midsternum as location. Describes pain as “tight and uncomfortable” upon movement or exertion. Mentioned an episode upon going up the stairs to bed. Most recent episode was three days ago after eating a large restaurant dinner. Denies radiation. Pain lasts for “a few” minutes and goes away when he rests. States “It has never gotten ‘really bad’” so he didn’t think it was an emergency, but is concerned after three episodes in one month and wants his heart checked out. Last physical was 1 year ago but says he hadn’t been checked out for several years prior. His regular diet includes grilled meat, some sandwiches, and vegetables. Reports grilling between 4-5 times a week, usually red meat. Has fast food for lunch on busy days. 1-2 cups of coffee a day. Denies coughing, shortness of breath, indigestion, heartburn, jaw pain, fatigue, dizziness, weakness, nausea, vomiting, and diarrhea. Denies chest pain at time of interview. No history of anxiety or depression.
- objective data:General Survey: Alert and oriented, with clear speech. Sitting comfortably in no acute distress. • Cardiac: S1, S2, without murmurs or rubs. S3 noted at mitral area. No swelling or fluid retention present. • Peripheral Vascular: No JVD present. JVP 3 cm above sternal angle. Left carotid no bruit. Right side carotid bruit. Right carotid pulse with thrill, 3+. Brachial, radial, femoral pulses without thrill, 2+. Popliteal, tibial, and dorsalis pedis pulses without thrill, 1+. Cap refill less than 3 seconds in all 4 extremities. • Respiratory: Breathing is quiet and unlabored. Breath sounds are clear to auscultation in upper lobes and RML. Fine crackles in posterior bases of L/R lungs. • Gastrointestinal: Round, soft, non-tender with normoactive bowel sounds in all quadrants; no abdominal bruits. No tenderness to light or deep palpation. Tympanic throughout. Liver is 7 cm at the MCL and 1 cm below the right costal margin. Spleen and bilateral kidneys are not palpable. • Neuro: Alert and oriented x 3, follows commands, moves all extremities. Gross cranial nerves 2-12 bilaterally and grossly intact. • Skin: Warm, dry, pink, and intact. No tenting and no sweating. • Musculoskeletal: Moves all extremities. • Psych: Normal affect, cooperative, good eye contact. • EKG (interpretation): Regular sinus rhythm. No ST changes.
differential diagnosis: angina pectoris, acute coronary syndrome
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