Cardiac Symptoms

HISTORY:

Cardiac symptoms for ‍ ‍hoursdays

‍chest pain, ‍retrosternal, ‍on exertionat restwith deep breath

‍palpitations

‍shortness of breath

‍shortness of breath on exertion, ‍IIIIIIIV/IV

‍decreased exercise tolerance

‍orthopnea

‍paroxysmal nocturnal dyspnea

‍leg swelling, ‍rightleftsymmetrical

‍weight gain, ‍ ‍lbskg over ‍ ‍weeksmonths

‍syncope

‍dizziness

‍fatigue

‍cyanosis

‍diaphoresis

‍nausea

Worsening factors: ‍exercise

Treatments tried: ‍none, ‍effectiveineffective



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Skin: ‍no rash

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍



ASSESSMENT:

‍Acute coronary syndrome ‍likelysuspectedpossible

DDx: ‍



PLAN:

- ECG

- Chest X-ray

- Blood work: ‍troponin, ‍d-dimers, ‍CBC, ‍lytes, ‍creatinine, ‍glucose, ‍LFTs, ‍albumin, ‍lipase, ‍Pro-BNP

- Stress test

- Echocardiogram

- CT angio of the chest

- Cardiac catheterization

- Lifestyle counseling: ‍sodium restriction, ‍fluid restriction, ‍increase exercise, ‍weight loss

- Smoking cessation counseling

- Moderate alcohol consumption

- Home blood pressure monitoring

- ‍Antiplatelets

- ‍Nitroglycerin

- ‍Statins

- ‍ACEs

- ‍ARBs

- ‍Beta-blockers

- ‍Calcium-channel blockers

- ‍Diuretics

- Referral to cardiologist

- Follow up in ‍ ‍weeksmonths

- Return if symptoms worsen or if new symptoms develop such as chest pain, shortness of breath, or fainting

- Go to ER if severe chest pain, severe shortness of breath, or fainting occurs