Scott Tyree (2002)

Full Answer Section

• Aggravating Factors: What makes the chest pain worse? (e.g., exertion, stress, cold air)
• Relieving Factors: What makes the chest pain better? (e.g., rest, nitroglycerin)
• Associated Symptoms: Are there any other symptoms, such as shortness of breath, sweating, nausea, or palpitations?
• Past Medical History: Any history of heart disease, high blood pressure, high cholesterol, or diabetes?
• Family History: Any family history of heart disease or sudden cardiac death?
• Medications: What medications are you currently taking?
• Allergies: Are you allergic to any medications or substances?
• Social History: Do you smoke, drink alcohol, or use recreational drugs?

Objective Information

A comprehensive physical examination should include:

• Vital Signs: Blood pressure, heart rate, respiratory rate, temperature, and oxygen saturation.
• Cardiovascular: Heart sounds, murmurs, and peripheral pulses.
• Respiratory: Lung sounds, respiratory effort, and use of accessory muscles.
• Abdomen: Abdominal tenderness, bowel sounds, and liver and spleen size.
• Extremities: Edema, skin color, and capillary refill.

Diagnostic Tests

Based on the patient's history and physical examination, the following diagnostic tests may be considered:

• Electrocardiogram (ECG): To assess heart rhythm and identify any abnormalities.
• Cardiac Enzymes: To detect myocardial injury.
• Chest X-ray: To evaluate lung function and identify any underlying lung conditions.
• Echocardiogram: To assess heart structure and function.
• Stress Test: To evaluate the heart's response to stress.
• Cardiac Catheterization: To visualize the coronary arteries and perform interventions, such as angioplasty or stent placement.

Abnormal Findings and Management

• Abnormal ECG: If the ECG shows ST-segment elevation or other abnormalities suggestive of acute coronary syndrome, immediate medical attention is required.
• Elevated Cardiac Enzymes: Elevated cardiac enzymes, such as troponin, indicate myocardial injury and require prompt treatment.
• Abnormal Chest X-ray: If the chest X-ray shows signs of heart failure or pulmonary edema, treatment may include diuretics and other medications.
• Abnormal Echocardiogram: If the echocardiogram shows reduced heart function or valve abnormalities, treatment may include medications, cardiac catheterization, or surgery.
• Abnormal Stress Test: If the stress test shows evidence of myocardial ischemia, treatment may include medications or revascularization procedures.

Differential Diagnoses

• Acute Coronary Syndrome (ACS)
• Pericarditis
• Aortic Dissection
• Pulmonary Embolism
• Musculoskeletal Pain
• Anxiety

Chosen Diagnosis: Acute Coronary Syndrome (ACS)

How ACS Affects Cardiac Health: ACS is a condition that occurs when blood flow to the heart is blocked. This can lead to myocardial ischemia, which, if prolonged, can cause myocardial infarction (heart attack).

Management Plan:

• Pharmacological: Aspirin, nitroglycerin, beta-blockers, and antiplatelet agents.
• Non-Pharmacological: Oxygen therapy, early revascularization (percutaneous coronary intervention or coronary artery bypass graft).

Patient Education:

• Importance of medication adherence
• Lifestyle modifications, including diet, exercise, and stress management
• Signs and symptoms of heart attack
• When to seek medical attention

Barriers to Comprehensive Care:

• Language barriers
• Cultural differences
• Lack of access to healthcare
• Financial constraints
• Time constraints
• Patient reluctance to disclose personal information

By addressing these barriers and providing culturally competent care, healthcare providers can improve patient outcomes and enhance the overall quality of care.

Sample Answer

Differential Diagnosis for Chest Pain

Subjective Information

To gather pertinent subjective information, I would ask the patient the following questions:

• Onset: When did the chest pain start? Was it sudden or gradual?
• Location: Where is the chest pain located? Does it radiate to other areas, such as the arms, jaw, or back?
• Duration: How long does the chest pain last? Is it intermittent or continuous?
• Character: How would you describe the chest pain? Is it sharp, dull, or achy?