Introduction
Sean is a 52-year-old man, who has an impressive history of hypertension. He stopped using his HTN medications three months ago. His current visit to the practice clinic is caused by the sudden chest pain accompanied with short of breath, nausea, and sweaty feeling. That condition lasted for about three minutes, then stopped, and never repeated. From that period, Sean feels tired from time to time. He did not work a lot after that event happened to him. Today, he feels more energy in comparison to the amounts of energy he had when he walked on the treadmill.
Further Questions for Ed
- Have you ever experienced heart failures before?
- Have you noticed the changes in your health when you stopped using your HTN medications?
- Have there been any changes in your life recently that could have some psychological or emotional effects?
- Do you feel anxious during the last days?
- How much time do you urinate per day?
- Do you wake up to urinate or drink water at night?
- Do you observe some changes or problems with your memory?
- Do you want to take some physical exercises? Or do you consider them as the obligation or duty that should be fulfilled?
- Do you want to change your place of life or make some other changes in your life?
- Have you had quarrels with your family or relatives recently?
- Do you always listen to the suggestions of your wife and follow her pieces of advice?
Differential Diagnoses
- Pneumothorax, unspecified (J93.9): is a sudden attack that is characterized by severe unilateral chest pain that has a pleuritic nature (Buttaro, Trybulski, Bailey, & Sandburg, 2013, p. 528). This condition includes the collection of extra air or some gas in the pleural space that causes the collapse of lungs. According to Bobbio et al. (2015), this condition has specific characteristics that conclude that older aged male people have more chances to have pneumothorax (p. 657). In this case study, the patient is a 52-year-old male, whose main complaint is the pain in his chest and the inability to breathe free for a couple of minutes. It was a single episode that looked like a heart attack, and pneumothorax could be a complication to expect in the patient with hypertension and heart problems.
- Atherosclerotic heart disease of native coronary artery without angina pectoris (I25.10): is the condition that is also known as coronary artery disease (CAD). This disease occurs when the damage to blood vessels that take responsibility for blood and oxygen transformation occurs. The main risk factors for this type of heart disease include hypertension, a high level of cholesterol, and smoking (Brown, 2014, p.52). In the situation under analysis, the patient has a rich hypertension history and a high level of cholesterol. He also smokes cigars while playing poker with his friends. Chest pain is the sign to check the condition of his heart in a short period of time.
- Anxiety disorder, unspecified (F41.9): is the psychological disorder that is usually characterized by anxious feelings and fears, tension and dyspnea, irritability and phobias. The connection between anxiety and cardiovascular disease has been discussed and proved by a number of researchers (Allgulander, 2016, p. 13). Anxiety is also common with dyspnea (Buttaro et al., 2013, p. 546). Sean suffers from his shortness of breath. He also reports on pain in his chest that was sharp and lasted for about 3 minutes. Besides, during the last three days, he felt some concerns about his condition and his abilities. He wants to be confident that there is no threat to his health. Still, fear is one of the symptoms of anxiety (Gorini & Riva, 2015, p. 215).
Body Systems to Examine and Tests to Offer
Pneumothorax is the disease that affects the respiratory system including lungs and the pleural cavity. The most frequently used method to diagnose the possibility of pneumothorax is X-rays (Sandionigi, Cortellaro, Forni, & Coen, 2013, p. 6). At the same time, computerized tomography remains to be the most sensitive method to detect a pneumothorax case (Sandionigi et al., 2013, p. 6).
CAD is the disease that affects the work of the circulatory system in a number of ways. It could lead to the problems with the heart and provoke heart attacks and heart failures. Besides, it includes such health problems as weakness, pain in the chest, and dizziness. Electrocardiogram (ECG), echocardiogram, and stress echocardiography are usually used to diagnose CAD in people (Skelly et al., 2016, p. 62).
Anxiety is the psychological disorder that cannot be diagnosed with the help of specially developed tests. The peculiar feature of this disorder is that it could influence various systems of the body. Doctors and psychologists try to pose as many questions as possible to define if the patient has some threats of being anxious. For example, the revision of the Diagnostic and Statistical Manual of Mental Disorders could be used to identify if older people are at risk of having an anxiety disorder (Mohlman et al., 2012, p. 549).
References
Allgulander, C. (2016). Anxiety as a risk factor in cardiovascular disease. Current Opinion in Psychiatry, 29(1), 13-17.
Bobbio, A., Dechartres, A., Bouam, S., Damotte, D., Rabbat, A., Régnard, J. F.,… & Alifano, M. (2015). Epidemiology of spontaneous pneumothorax: Gender-related differences. Thorax, 70(7), 653-658.
Brown, C.H. (2014). Heart disease in women: Different than in men? US Pharmacist, 39(9), 51-54.
Buttaro, T.M., Trybulski, J., Bailey, P., & Sandburg-Cook, J. (2013). Primary care: A collaborative practice. (4th ed.). St. Louis, MO: Elsevier Mosby.
Gorini, A., & Riva, G. (2014). Virtual reality in anxiety disorders: The past and the future. Expert Review of Neurotherapeutics, 8(2), 215-233.
Mohlman, J., Bryant, C., Lenze, E. J., Stanley, M. A., Gum, A., Flint, A.,… & Craske, M. G. (2012). Improving recognition of late life anxiety disorders in diagnostic and statistical manual of mental disorders: Observations and recommendations of the advisory committee to the lifespan disorders work group. International journal of geriatric psychiatry, 27(6), 549-556.
Sandionigi, F., Cortellaro, F., Forni, E., & Coen, D. (2013). Lung ultrasound: A valid help in the differential diagnosis between pneumothorax and pulmonary blebs. Emergency Care Journal, 9(3), 6-8.
Skelly, A. C., Hashimoto, R., Buckley, D. I., Brodt, E. D., Noelck, N., Totten, A. M.,… & McDonagh, M. (2016). Noninvasive Testing for Coronary Artery Disease. Comparative Effectiveness Reviews, 171. Web.