Case Study Of Chest Pain Discussion Paper
Jackie Johnson suffers from chest pain that is intense and retrosternal. The pain emits to her back and is pleuritic because it worsens when she inhales deeply. This pain is reduced when she leans forward. The key driver for the possible diagnosis is the three-element high pitched screeching sound during cardiac auscultation. This is a pericardial rub. With all these factors together, this client certainly has severe pericarditis.
The constant irritation of the pericardium can result in fibrosis which can ultimately cause constrictive pericarditis. Distention of the jugular vein and a rise in the pressure of the jugular vein can be observed. Based on these indications, the differential diagnosis may include certain things like pulmonary embolism, GI reflux disorders, and pneumonia (Hammer and McPhee, (2019) Case Study Of Chest Pain Discussion Paper.
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Pericarditis is most commonly caused by infections. Hammer and McPhee (2019) confirm that Coxsackievirus is the most common viral trigger. Bacterial triggers, like pneumococcal and tuberculosis or fungal causes like coccidioidomycosis and actinomycosis, can cause Pericarditis (Hammer & McPhee, 2019). Several tests should be run including CXR, lipase levels, troponin, BMP, CBC, and EKG. Because of the erythematic oropharynx and her flu-like manifestations, I would say the patient’s cause was viral. Additionally, she has clear mucus in her nasal passage. If these tests were to be carried out, increased CRP level, erythrocyte sedimentation rate, or WBC would be probable. The patient’s EKG would be normal. In ruling out each trigger, the CXR may be beneficial. Pericarditis is a pericardium infection, which affects the surrounding pleura. This can cause pain in coughing and breathing deeply (Hammer and McPhee, 2019)Case Study Of Chest Pain Discussion Paper.
The patient should take proper care of herself after discharge to avoid recurring pericarditis. 20-50 percent of all pericarditis-treated patients acquire it at a later stage. She needs to go on her prescribed medications, which could be steroids and colchicine to ensure that these medicines are correctly tapered off. The dosage of colchicine may be minimal, whereas large doses or long periods of usage may be harmful (Rahman, 2017). The patient may also take NSAIDs to give symptom management, quicker recovery speeds, and a decrease of potential exacerbations (Imazio et al., 2016). They can only be used if they is not contraindicated to use with her other medicines. She needs to make follow up visits to ensure that this problem is fixed Case Study Of Chest Pain Discussion Paper.
References
Fox, K., Prokup, J. A., Butson, K., & Jordan, K. (2020). Acute effusive pericarditis: A late complication of COVID-19. Cureus, 12(7).
Hammer, G., & McPhee, S. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Medical.
Imazio, M., Lazaros, G., Brucato, A., & Gaita, F. (2016). Recurrent pericarditis: new and emerging therapeutic options. Nature Reviews Cardiology, 13(2), 99.
Rahman, A., & Saraswat, A. (2017). Pericarditis. Australian Family Physician, 46(11), 810.
Jackie Johnson, a 35 y.o. African-American, married female, advertising executive, presents to the emergency department with complaints of chest pain. The pain is described as 8 on a scale ranging from 1 to 10, retrosternal, and sharp in nature. It radiates to the back, is worse with taking a deep breath, and is improved by leaning forward. On review of systems, she has noted a “flulike illness” over the last several days, including fever, rhinorrhea, and cough. She has no medical history and is taking no medications. She denies tobacco, alcohol, or drug use. On physical examination, she appears in moderate distress from pain, with a blood pressure of 125/85 mm Hg, heart rate 105 bpm, respiratory rate 18/min, and oxygen saturation of 98% on room air. She is currently afebrile. Her head and neck examination is notable for clear mucus in the nasal passages and a mildly erythematous oropharynx. The neck is supple, with shotty anterior cervical lymphadenopathy Case Study Of Chest Pain Discussion Paper.
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The chest is clear to auscultation. Jugular veins are not distended. Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal. In this discussion: Provide and discuss this patient’s likely diagnosis with your colleagues. Why do you support this “likely” diagnosis? Discuss your differential diagnoses clinical reasoning. Why do you support this list of potential differential diagnoses? Provide and discuss what the most common causes of this disease are, and which is most likely in this patient? Identify the pathophysiologic mechanism for her chest pain. Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports. Support your discussion with citations from the external literature and your textbook. Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria Case Study Of Chest Pain Discussion Paper