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Week 7 – digital clinical experience: assessing the heart, lungs, and | NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning | Walden University

Assessment and Priority Diagnosis

Brian Foster, a male of 58 years, has shortness and chest pains. His past medical history includes hypertension and smoking. Brian says that his symptoms are getting worse over the last few weeks.

Based on Brian’s symptoms and medical history, the priority diagnosis is Acute Coronary Syndrome (ACS). The term ACS refers to a wide range of clinical signs and symptoms that are caused by myocardial hemorhage interruption (Morrow, et al. 2019, 2019). To prevent further complications such as death or myocardial injury, ACS must be treated immediately.

Differential diagnoses

  1. Pulmonary Embolism, (PE)

A potentially fatal condition, PE occurs when blood clots travel to the lungs and block blood flow. Shortness of breath and chest pain can all be symptoms of PE. These are very similar to ACS symptoms. PE can be ruled out by performing a CT angiogram or a ventilation-perfusion scan (Konstantinides et al., 2020).

  1. Aortic Dissection

An uncommon but deadly condition, aortic dissection can cause chest pain and shortness of breathing. The inner layer of your aorta tears, blood gets into the wall of your aorta and causes a false lumen. A CT scan, or magnetic resonance imaging, (MRI) can help confirm this diagnosis. Erbel et.al. (2014).

  1. Pneumonia

Pneumonia, a common upper respiratory infection, can cause shortness of breath and cough. Patients who smoke can have pneumonia mistakenly confused for an acute coronary syndrome (ACS). For confirmation of the diagnosis, you can use a chest radiograph or computed tomography scan (CT). Mannell et. al. 2020.

  1. Pericarditis

Pericarditis can be described as inflammation of your pericardium. This condition may present with chest pains, breathlessness, or cough. Pericarditis symptoms can look similar to ACS. The electrocardiogram can help distinguish the conditions. Pericarditis is usually characterized by diffuse ST segment elevation. (Imazio and al. 2015).

  1. Gastroesophageal reflux Disease (GERD).

GERD, a common digestive disorder, can cause chest pain, breathing difficulties, as well as coughing and shortness. GERD symptoms may mimic ACS. This is especially true for patients who are hypertensive and smoke. To confirm diagnosis, proton pump inhibitors can be tried (Katz 2018,).

References:

Erbel, R., Aboyans, V., Boileau, C., Bossone, E., Bartolomeo, R. D., Eggebrecht, H., Evangelista, A., Falk, V., Frank, H., Gaemperli, O., Grabenwöger, M., Haverich, A., Iung, B., Manolis, A. J., Meijboom, F., Nienaber, C. A., Roffi, M., Rousseau, H., Sechtem, U., … Vahanian, A. (2014). ESC Guidelines for the Diagnosis and Treatment of Aortic Diseases: This document covers acute and chronic aortic disease of the thoracic or abdominal aorta. European Society of Cardiology Task Force for the Diagnosis & Therapy of Aortic Diseases. European Heart Journal, 35(41), 2873–292

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