Let's study Medical English. CHEST PAIN.P1
You are going to observe and participate in a clinical encounter of a patient who comes to the office with a complaint of chest pain.
As you observe the encounter, you will be asked to answer questions while the image on the screen freezes. Such questions will allow you to practice history-taking and physical examination skills as well as your clinical reasoning skills in developing an assessment or differential diagnosis and a plan—that is, an appropriate next diagnostic workup.
You will have time to record your findings and receive feedback.
HEALTH HISTORY
Tell me your special concerns today.
I’m a little worried because I have been having sharp pains in my chest for the last two weeks.
What findings might be important to look for as you observe this patient?
Level of distress.
Labored breathing.
Skin color: central and peripheral cyanosis.
Respiratory rate.
Two weeks ago I was reading a story in the paper about a car crash, when I noticed sharp pains in my left chest. I was sweating and short of breath for about 5 minutes. And my heart felt like it was racing.
What possible causes of chest pain are you considering?
Angina.
GERD.
Panic attack.
Musculoskeletal chest wall pain.
Can you tell me how severe the pain was, on a scale from 1 to 10, with 1 being very faint and 10 being severe?
I was 5 over 10.
Did it move into your neck or down your left arm?
No, no it was just in my chest.
How have you been since then?
I’ve had two other episodes, one of them was about 10 days ago when I was lifting some books, the other was about 5 days ago when I was talking with my sister about our father’s death. He died 3 months ago in a car crash.
Did you have any other symptoms when you had these chest pains?
Yes, I had the same sweating and shortness of breath, with some light‐headedness during the most recent one.
What was the level of pain?
The same, about 5 out of 10 for about 5 minutes. Then the pain just went away while I was sitting there. I keep feeling so lost and panicked since my father died.
How are you feeling today?
Today I’m feeling fine, but I haven’t been sleeping well. It’s strange, I never felt anxious or depressed before.
What cardiovascular risk factors do you need to consider in this patient? And which one has the highest risk for coronary artery disease?
The risk factors are:
Family history of coronary artery disease.
Hyperlipidemia, hypertension, smoking, diabetes.
For women, preeclampsia and collagen vascular disease.
Family history conveys highest risk.
Do you have any problems with acid reflux? Or have you done any heavy lifting or strenuous exercise?
No, I’ve never had any stomach problems and I don’t really exercise much.
Do you have a history of high blood pressure? I noticed today your blood pressure was 140 over 95.
Yes, well I did have high blood pressure during my three pregnancies, I think it was about 145 over 90, but the deliveries were fine.
What about smoking?
When I was in my 20s I smoked about a pack a day for about 4 years.
Do you drink any alcohol?
I have 1…or 2 glasses of wine maybe 3 nights a week, more recently to help me relax.
Is there any heart disease in your family?
Yes, my brother had bypass surgery when he was 48, and my mom died of a heart attack when she was 62.
What about high cholesterol, or is there any diabetes in the family?
No, I’ve never had trouble with my cholesterol and we don’t have diabetes in my family.
You’ve given me a good picture of your symptoms, and I can see why you’re concerned. Is there anything you think we may have missed?
No, but I can’t get away from these flashbacks about my father’s accident.
It’s common to visualize scenes like a crash with a loved one. Let’s do your physical examination, and then we can talk more.
Sài gòn 13/11/2022
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