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Cardiovascular conditions may differ in symptoms depending on the patient’s age, gender, and previous medical history. In women, some conditions can present additional problems or be asymptomatic (McSweeney, Pettey, Souder, & Rhoads, 2011). In Case Study 2, a 63-year-old African-American woman comes to the office with a complaint of intermittent chest pain that started two weeks ago. The patient’s signs and physical examination point to several diagnoses that require immediate intervention to prevent other severe issues from developing. The differential diagnosis includes stable angina, myocardial infarction, and costochondritis, and a treatment plan for the primary diagnosis is offered.
The first differential diagnosis is stable angina (angina pectoris) – chest pain that occurs due to reduced blood flow. The main symptoms of this condition include chest pain defined as pressure or burning, pain in the extremities or one’s jaw, neck, and back, fatigue, dyspnea, nausea, and sweating (Manolis et al., 2016). Furthermore, angina-related signs appear after physical exhaustion and can be mitigated by rest and medication (Manolis et al., 2016).
The patient’s description of the pain, as well as relieving and exacerbating factors, meets the description of stable angina. The palpation reveals the tenderness of the chest wall, and the blood pressure (BP) is raised, which is a common risk factor for angina.
The second possible diagnosis is a myocardial infarction, the blockage of blood to one’s heart. The signs of a heart attack are tightness or pressure in the chest, nausea, heartburn, abdominal pain, fatigue, sweating, and dizziness (Ford, Corcoran, & Berry, 2018). The patient’s high BP and age put her at increased risk of myocardial infarction. However, the patient states that pain resolves with rest, and she does not have any other symptoms. Thus, this diagnosis is less likely, although the risk of myocardial infarction exists if the patient’s pain remains unresolved.
Costochondritis is the final differential diagnosis because it is established by exclusion. This condition’s signs resemble those of angina and myocardial infarction, but they are caused by an inflammation of one’s cartilage (Boran & Boran, 2017). If diagnostic tests exclude angina, myocardial infarction, and show some characteristics of an infection, then this diagnosis can be considered. However, it is first necessary to review other systemic problems that are more urgent.
Treatment and Patient Education
The description of the signs and patient’s history shows that angina is the primary diagnosis. A repeat tress test, electrocardiogram, chest X-ray, and such blood tests a CBC, blood cultures, cardiac enzymes are crucial to rule out other conditions and support the final diagnosis (Tharpe, Farley, & Jordan, 2017). Angina can be a precursor to infarction or acute coronary syndrome, which may develop later. Thus, lifestyle change has to start immediately and be focused on healthy eating, safe exercising, and BP management.
Pharmacological treatment for the patient with angina and high BP is a combination of beta-blockers or non-dihydropyridine calcium channel blockers with BP control medication (Manolis et al., 2016). The management plan adds Metoprolol 50 mg orally twice a day to the patient’s Lisinopril to see how BP will change (“Metoprolol dosage,” 2019). Patient education should focus on nutrition, safe physical activity, stress management, and BP reduction.
Overall, the second case study presents a patient with multiple cardiovascular conditions that may affect each other and lead to severe problems if left untreated. The patient’s primary diagnosis is angina, but diagnostic tests are crucial to eliminating differential diagnoses. The treatment plan focuses on lifestyle changes, BP control, and blood flow improvement. Patient education has to include such information as healthy food choices and an exercise regimen that is not challenging.
Boran, M., & Boran, E. (2017). Tietze syndrome and idiopathic costochondritis – Treatment modalities, recurrence rates, seasonality. World Journal of Pharmaceutical Research, 6(8), 76-85.
Ford, T. J., Corcoran, D., & Berry, C. (2018). Stable coronary syndromes: Pathophysiology, diagnostic advances and therapeutic need. Heart, 104(4), 284-292.
Manolis, A. J., Poulimenos, L. E., Ambrosio, G., Kallistratos, M. S., Lopez-Sendon, J., Dechend, R.,… Camm, A. J. (2016). Medical treatment of stable angina: A tailored therapeutic approach. International Journal of Cardiology, 220, 445-453.
McSweeney, J. C., Pettey, C. M., Souder, E., & Rhoads, S. (2011). Disparities in women’s cardiovascular health. Journal of Obstetric, Gynecologic & Neonatal Nursing, 40(3), 362–371.
Metoprolol dosage. (2019). Web.
Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery & women’s health (5th ed.). Burlington, MA: Jones & Bartlett Publishers.