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¶ … 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...
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…
References
Ben-Dor, I., Battler, A. (2007). Treatment of stable angina. Heart, 93(7): 868-874.
Ibrahim, A. (2012). Troponin-negative chest pain -- a diagnostic evasion? BMJ,
344:e1682.
Kyziridis, T. (2005). Notes on the history of medicine. German Journal of Psychiatry, 8: 42-48
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