History of the Patient

Discuss about the Case Study of Chest Pain.

The report is a basic representation of the case who is suffering from severe chest pain and she is brought in the emergency department of the city Hospital. The report discusses the various diagnostic criteria, differential diagnosis and the treatment processes of the patient. It also observes the history and the present condition of the patient.

Presenting the complaint of the patient

Julie is a 50-year-old man who is a New Zealand origin was admitted in the hospital yesterday at 5 ma in the morning with the complaint of acute and crushing chest pain. She has reported that he woke up at 4 am in the morning with a substernal form of pressure and the patient felt that somebody was standing on his chest. She has also experienced a huge amount of breathing problem while he was taken to the hospital. On the way to the hospital, he was given 0.4 mg of nitroglycerin to get some sort of relief. She also began to sweat heavily in the ambulance. He has also vomited once in the ambulance. She also reported that the rate of chest pain is about 6 out of 1-0 in the scale of pain. The pain has not radiated since the last few minutes. On his arrival in the Emergency department of the hospital, he has complained that he is still under the problem of hid pressure in the chest and now his pain has mediated to his hands and jaws. There were no signs of pain in the back and the abdomen from his complains. She was immediately given oxygen in the emergency department for improving his loss in breath. Therefore, after a while he was in the emergency ward he was experiencing nausea.

History of the presenting problem

Julie has complained that he has been having chest pain from past two weeks. She observed that she was suffering this pain whenever he was at rest sitting or sleeping, while exercising and also while taking his meals. Julie is a patient of Hypertension from the last five years and she also under medication for the same.

She has complained that he has recurrent form of chest pain is like a pressure in the left side of the heart. She also reported that the rate of chest pain is about 6 out of 1-0 in the scale of pain. The pain has not radiated since the last few minutes.

History of the Presenting Problem

Family History

Julie did not have any childhood disease and never have been gone through any surgery rather than when her son was born. She is the only daughter of her parents. Her father died at the age of 60 years due to severe cardiac arrest.

Julie is a renowned architect in New Zealand and she lives with her husband and her son. She is married to her husband since 30 years.

In case of woman, the clinicians often misjudge the chest pain and tend to evaluations the pain of the chest to be a normal pain overlooking the symptoms of the angina pain. However, there are huge level of differences that do exist in the frequency and the quality of the symptoms that are been seen in male patients to the female patients (Wang et al., 2014). In a research it was also found that out of 3100 patients who were undergoing the test of stress exercise, 28% were woman and 55% were male who were currently suffering from acute form of angina; pain.

Women are always more likely to have the symptoms of unexplainable form of nausea, shortness of breath, fatigue, back pain and sleep disturbances compared to the men.  In the patients who do actually are not presently having the symptoms of  acute coronary heart disease, myocardial infarction has been found to have occurred twice as likely in men as in women. In case of the acute coronary syndromes (ACS), the initial form of presentation of the chest pain is more often to be common in the men than the women (Zhang et al., 2017).  However, the women with the acute form of MI are always known to be the older and more susceptible form of the complications, and hence making of the diagnosis for them is a key. The presence of the hypertension or diabetes always tends to increases the probability of the diagnosis of acute form of heart diseases.

It is important that we recognize that the men and the women comes across the same form of diseases and they also respond to the acute myocardial infarctions within the given context of the societal influences (Mozaffarian et al., 2014). They tends to lay their public believes to the following that are the most common form of symptoms of heart attack, which includes chest pain, irregular heartbeat, shortness of breath, and an inability to move. However, there are clinicians who certainly use the classical symptoms of the diaphoresis, nausea and vomiting, weakness, and syncope for the assessment of the patients (Zhang et al., 2017).

Family History

It is very interesting to observe that the psychosocial factors that are very much important in case of women than that of the men.  Women always tend to misjudge their own risks of heart diseases.  Several Studies have observed that the women have been experiencing such symptom of the MI more often that are attended to their various forms of the social form of responsibilities as the mother or the homemaker, whereas the men have their sole focus is on the need for the care of their symptoms.  The co morbidity is an essential form of knowing all about the diagnostic criteria of cardio vascular disease. Firstly due to constant pain in the chest can be hint of severe form of regarding the heart. It has been generally seen in patients that due to advanced age they are having angina pain. Second reason can be diabetes. The third sign can be the pain in the jaws, neck and lower abdomen (Mozaffarian et al., 2014). Fourth sign can be the shortening of the breath and the last sign can be the nocturnal angina or due to angina due to severe mental stress.

The physical examination of the patient with acute chest pain is the best way to know their health conditions. The abnormalities that are revealed in the examination of the acute cardiac pain includes the abnormalities in the rate of the pulse and the heart sounds, the hypo or the  hypertension, and that can be the signs of heart failure (Mozaffarian et al., 2014).

The crepitation reveals that by auscultation in one or both the bases suggests signs of pneumonia or the case of failure in the heart. There has been reduced sound in the breath on one of the side that can be caused by the pneumothora or are produced focally due to the collapsed lobe.

Any form of tenderness on the palpation over the areas of the chest can cause pain that are usually indicates the cause of the musculoskeletal problems that generally includes costochondritis (Crippa et al., 2014). However, there are many patients who are been diagnosed with MI and also have gone acute chest wall pain on the presentation.

Any origin of gastrointestinal problems can create chest pain that are associated with the normal form of the cardiac and the respiratory examination, that are unless they are existing but they are in a stable co morbidity (Crippa et al., 2014). An abnormal abdominal are more likely to make the examination of the etiology of gastrointestinal problems. Basic observations are also to be done that generally includes the temperature, BP rate of the pulse and the rate of the heart (Crippa et al., 2014).

Social and Professional History

However, in case of Julie she was feeling nausea when she was taken to the emergency department. Her Blood Pressure is quite high that was 140/120, her heart rate was irregular, her oxygen saturation rate was about 80% and she had the complaint of acute chest pain.

The ECG that is performed in most of the patients are not done unless there is a non-cardiac diagnosis that can be made with super confidence. The ECG of the patient should be done as soon as possible after presentation from the doctor (Crippa et al., 2014). The CXR can be confirmed when the  respiratory disorders such as pneumothorax or pneumonia does exist. The cardiac ischaemia is generally characterised by the normal form of the CXR, but there are CXR that can provide the  clues that are serious for the cardiac pathology, that has the widened form of mediastinum in the aortic dissection or a very large globular heart in the cardiac tamponade.

There are blood tests that are also done on the basis of the present of the patients.

• An FBC should be ordered to screen for anaemia and evidence of infection.
• A renal profile is useful as a baseline test.

There are some of the further investigations that are needed to be done to confirm the suspected diagnosis.

Coronary angiography is required urgently in patients with a STEMI and in patients with an NSTEMI who have high-risk features such as ongoing chest pain and dynamic ECG changes.

The various causes of the cardiac arrest  includes the  arrhythmias, structural form of the heart disease, and the myocardial dysfunction . The non-cardiac form of causes that includes the processes that have increased the preload, increased the different forms of the after load and therefore reduce the rate of the oxygen-carrying capacity of the blood (Newcomb et al., 2013). For instance, in case of the renal failures it can result in the heart failure due to the several fluid retention and anemia. The lymphatic form of the obstruction and the venous obstruction syndromes can be a major cause states that forms of edema, and obesity-hypoventilation syndrome (OHS) that can eventually lead to the right-sided failure of the heart with right side ventricular hypertrophy.

The diastolic form of the heart failure may be the most common form of the heart failure among the population of Australia. There are alterations in the ventricular and the arterial coupling that can appear to have the key importance in the impairment of the responses of the hemodynamic response to the exercise, but there are diagnosis of the diastolic heart failure that cannot be neglected  even in the existence of the  normal form of the diastolic function at its rest (Newcomb et al., 2013).

Three Early Diagnostic Considerations

The failure of the heart should be differentiated from the pulmonary edema that are associated with the injury that are found in the alveolar-capillary membrane of the heart and that are caused by the diverse form of the etiologies (Newcomb et al., 2013). The increased form of the capillary permeability is the observed form of the trauma, shock infections in the respiratory tracts, hemorrhagic, sepsis, administration of the several drugs, and the ingestion of the toxins (eg, heroin, cocaine, toxic gases). Several features may also differentiate between the carcinogenic from noncardiogenic pulmonary edema. For the patients with heart failure, the history for the acute form of cardiac arrest and the progressive form of the heart failure symptoms are always present.  The physical form of examination may yield clues to acute heart failure.

In the elderly patients, confusion and fatigue can eventually be one of the first sort of symptoms for the failure of the heart, which is obviously related to the decrease in the cardiac output.

Various diagnostic tests are to be conducted to be sure that what kind of disease the patient is suffering through.

Coronary angiogram

The coronary angiogram is generally done when the patient is having major or minor heart attack. It is done to know the current position of the heart. It is also known as cardiac catheterization.

The coronary angiograms helps rthe doctors to understand the best treatment that can be given to the patient. Sometimes coronary angioplastisity is the best way to treat the heart blockage. The cardiologist will discuss this option with you before the procedure and it is your choice whether to proceed

In case of the heart diseases, there are various forms of the substances that are seen in the blood of the patient’s body. However, the blood tests can also measure the level of the toxic substances and can also tell that how much damage has been occurred in the heart.

The most common test that are done for checking the level of heart attack is through the test of the level of troponin in the body. Blood test are also needed for the observation of the other particles like fat, minerals and cholesterol.

The monitoring of the blood pressure are also one of the common factor that can cause severe disease in the patient. In this case Julie is suffering from hypertension and is under medication for the same. Therefore, it is very important to monitor the level of the blood pressure of the patient in a frequent interval.

Physical Examination

The chest X ray are also helpful as they can guide the patients to know that there are any signs of the heart attack or not.

Echocardiogram (heart ultrasound)

It is a common form of heart ultrasound that gives the picture of the functioning of the heart. It uses the probe towards the chest and sometimes it comes down to the esophagus.

This test helps the doctor to check whether the problem lies in the heart valves and chambers or the problem is with the heart-pumping rate.

An MRI is actually the very strong magnets that are created by the radio waves to get a detailed image of the heart on the computer. It can take the pictures that are still or moving from the heart of the patient. Sometimes it has the special dye that is used for making the parts of the heart and the coronary arteries easier to see.

The stress test helps the doctor to know how the heart works and how the patients should remain active physically. This is done generally done by testing the stamina of the patient through the treadmill running.

The Doctors usually use the tilt tests to observe whether there are different body positions that will eventually trigger the abnormal beat of the heart. They are very much useful for the investigating of the hearts of the people who can faint without any explanation.

The heart muscles are the most important muscles of the body. The coronary artery disease is the disease that are generally referred to the disease that are build up of the cholesterol in the layers of the artery that causes the blood flow in the body that may produce the arteries that may cause the blood flow to slower down and stop.

The heart disease is the result of the plaque that are build up for the arteries of the population that blocks the flow of the blood that tends to heighten the risk of the heart attacks and the stroke. These heart diseases can cause the blockage and clotting in the heart that results in causing the attacks in the heart.

There are arteries in the body of the individuals that are smooth and elastic. They become narrow and it also become starved for the level of the oxygen that can be vital in the nutrients that are needed for the pumping of the blood in a proper way.

The plaques eventually release its chemicals that have promoted the process of the healing but it makes the inner side of the walls of the vessels of the blood very sticky. Then there are other substances, that include the inflammatory cells, calcium and the lipoproteins that can travel in the bloodstream of the patient and can start with the sticking of the inside of the vessel walls. Eventually, a there is a narrowed form of the coronary artery that may develop in the new vessels of the blood that can go around the various blockage to get the blood that is flowing in the heart. However, when there is a increased form of exertion of the body or stress, the new form of the arteries may be unable to supply the enough amount of the oxygen-rich blood to the muscles of the heart. In some of the cases, the clot in the blood may eventually block the supply of the blood to the muscles of the heart that may cause the heart attack. However, if the vessels of the blood that are connected to the brain are blocked, usually forms clots in the blood that can result in a  ischemic stroke.

However, in case of Julie, she was suffering from 30% heart blockage so the doctor have prescribed to get a angioplasting done as soon as possible.

Conclusion

From the above report we can hence conclude that Julie is suffering from cardio vascular disease and she needs to go through angiogram to reduce the rate of her heart blockage

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