St. Thomas University
This patient is a 75-year-old woman who presents with complaints of chest pain. Chest pain is a common presenting symptom with various causes (Ayerbe, González, Gallo, Coleman, Wragg, & Robertson, 2016). This patient’s chest pain began when she was walking up the steps and at that time, she rated it an 8 out of 10. In order to collect more subjective data, I would ask this patient to describe her pain in more detail. First, I would ask her to describe the pain. This patient described her pain as burning or aching. I would want to know if the burning, aching pain was constant or if it would come and go. The patient denied that the pain radiated to her arm, but I would ask if it radiated to the upper chest. I would ask her if she was diaphoretic when the pain occurred. I would also ask the patient if laying down caused more pain. Other questions to ask this patient would be if she took anything to try and relieve the pain and I would ask her about any drug or alcohol use in her present or past. Cocaine use can cause coronary spasms (Rhoads & Wiggins Petersen, 2021). I would also ask the patient if she has a history of anxiety.
When conducting the physical assessment on this patient I would gather more objective data. I would assess the patient’s skin color, mucous membranes, and lips to assess for cyanosis or anemia. I would assess her skin temperature as well and check to see if she was diaphoretic. I would also assess the patient’s eyes and check for Xanthelasmas and any skin or nail changes, which may be present in a patient with angina (Zitkus, 2010). Changes in skin texture and hair distribution may also be present in peripheral vascular disease.
The diagnostic tests that I would order would be an electrocardiogram (ECG), a troponin I level, an X-Ray of the digestive system and chest, and an endoscopy. The ECG and troponin lab would be done to rule out any cardiac abnormalities or if the patient may have had a myocardial infarction, and this patient does not appear to be in acute cardiac distress. The other tests would be done to assess for a possible gastrointestinal cause for her chest pain. Non-cardiac chest pain can cause angina like pain in patients without heart disease.
Three differential diagnoses that I would give for this patient are Gastroesophageal reflux (GERD), esophageal motility disorders, and gastric ulcer. I believe that this chest pain is related to a gastrointestinal cause because gastrointestinal pain can be described as a burning sensation in the middle of the chest (Rhoads & Wiggins Petersen, 2021). However, thee diagnoses can only truly be made after ruling out any cardiac related chest pain, as cardiac related chest pain caused by a myocardial infarction may have similar symptoms (Frieling, 2018). GERD is a common cause of non-cardiac related chest pain, and it is attributed to up to 60% of non-cardiac chest pain diagnoses (Frieling, 2018).
Ayerbe, L., González, E., Gallo, V., Coleman, C. L., Wragg, A., & Robson, J. (2016). Clinical assessment of patients with chest pain; a systematic review of predictive tools. BMC cardiovascular disorders, 16, 18. https://doi.org/10.1186/s12872-016-0196-4
Frieling, T. (2018). Non-Cardiac Chest Pain. Visceral Medicine, 34, 92-96. doi: 10.1159/000486440
Rhoads, J., & Wiggins Petersen, S. (2021). Advanced Health Assessment and Diagnostic Reasoning. Burlington, MA: Jones and Bartlett Learning.
Zitkus, B. (2010). Assessing chest pain accurately. Nursing2010, 40, 1-6 doi: 10.1097/01.NURSE.0000389904.40627.35