Heart Attack Signs and Symptoms in a Patient

¶ … Sean at this visit?

Ten questions to develop the diagnosis would be:

How often do you drink or smoke (how often do you play poker?) How many drinks? How many cigars? More/less frequently than usual? Same?

Have you had any recent illnesses?

What does your diet consist of?

What is your cholesterol level?

Have you had any fever?

Are you experiencing any stress?

How long had you been working out prior to occasion? How often/frequently? How much weight had you lost?

How much rest are you getting at night?

What is your diet?

Are you sweating more than usual? Have you had pain in any other parts of your body? Have you had a rapid or irregular pulse? Any swelling in lower extremities?

What is your differential diagnosis list for this visit thus far with rationale?

Likely diagnosis: Acute coronary syndrome. Differential diagnosis for this patient is based in the family of coronary heart disease, with the differential diagnoses possible being hypertension, stroke, stable angina, heart attack, esophageal spasm, esophageal rupture, atherosclerosis, pericarditis, pulmonary embolism, aortic stenosis, aortic dissection (Ibrahim, 2012). The patient has a history of hypertension and was previously taking medication for it. For a while, he has not been taking this medication and has felt all right, but the 3 minutes of shortness of breath, pain in chest, and nausea and sweating indicate that there is a coronary heart disease of some kind underlying the veneer of otherwise healthiness. It may be stable angina, given the brevity of the symptoms. It may be the hypertension reasserting itself. It may be a mild heart attack.

The frequency of his smoking and drinking is also a telling sign of stress on arteries and his diet and/or (lack of) exercise may indicate level of cholesterol/plague build up in arteries.

Based on your differential diagnoses list, identify what body systems you'd examine along with pertinent positive/negatives in each system and any diagnostic tests you would like to perform?

ECG to test electrical activity of heart to see if injured heart muscle is existent; waves are monitored for positives or negatives. Blood tests can follow to indicate whether heart enzymes are in the blood, indicating through positives and negatives whether heart has been damaged and allowed these enzymes to leak into the blood stream: a positive would indicate a heart attack, a negative would not. If ECG shows positive waves and the blood test shows negative for enzymes, blood flow can be checked to determine strength of arteries. Echocardiogram for sound waves bounced off the heart using a transducer for an electronic image to view if heart looks damaged. Coronary angiogram to test artery blockage should be given, with catheter inserted in leg. Stress test may also be given to measure heart and blood vessels and how they respond to physical exertion.

Hemoglobin could also be taken to test for diabetes which could also be a cause of heart problems. The rationale for this treatment modality is found in the study by Ben-Dor and Battler (2007) which shows that long-acting nitrates can effectively reduce angina symptoms. The stress relief is based on the findings of Kyziridis (2005) who shows that stress relief is a good therapeutic and can come in various forms through participation in society, exercise, relaxation.

The diagnosis of the client, that he has stable angina related to coronary disease, is based on the symptoms and signs that the client has demonstrated. The ICD-9 code is 413. It is a reoccurring symptom that is relieved through rest. However, it is aggravated by the diet, the lack of exercise, the smoking, drinking and stress, if any.