Posted: January 25th, 2023
Chest Pain
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?
PLEASE ANSWER THE 3 QUESTIONS ABOVE, AFTER DEVELOPING THE ANSWER CREATE A RATIONALE FOR EACH QUESTION
NO PLAGIO MORE THAN 10 %
2 REFERENCES NO OLDER THAN 5 YEARS
SOLUTION
Chest pain can be caused by a variety of medical conditions, including heart disease, lung problems, gastrointestinal issues, and musculoskeletal conditions. The specific type and location of chest pain, as well as other symptoms present, can help to determine the underlying cause. A thorough medical evaluation, including a physical examination, laboratory tests, and imaging studies, may be necessary to make a diagnosis.
It is important to seek immediate medical attention if chest pain is accompanied by shortness of breath, sweating, nausea, or fainting, as these may be signs of a heart attack or other serious condition. If you have chest pain and are unsure of the cause, it is best to consult a healthcare professional for further evaluation.
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