Cardiac Symptoms

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of cardiac symptoms

Symptoms include:

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍palpitations

‍shortness of breath

‍shortness of breath on exertion, ‍IIIIIIIV/IV

‍decreased exercise tolerance

‍orthopnea

‍paroxysmal nocturnal dyspnea

‍leg edema, ‍rightleftsymmetrical

‍weight gain, ‍ ‍lbskg over ‍ ‍weeksmonths

‍syncope

‍dizziness

‍fatigue

‍cyanosis

‍diaphoresis

‍nausea



Worsening factors: ‍exercise

Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍smoking

‍excessive alcohol consumption

‍sedentary lifestyle

‍obesity

‍high cholesterol diet

‍stress

no history of: ‍coronary artery disease, ‍heart failure, ‍hypertension, ‍diabetes, ‍high cholesterol, ‍previous heart attack, ‍heart valve disease, ‍arrhythmia

no family history of: ‍heart disease





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Acute coronary syndrome ‍likelysuspectedpossible

DDx: acute coronary syndrome, myocardial infarction, angina pectoris, atypical chest pain, non-cardiac chest pain, arrhythmias, valvular heart disease, cardiomyopathy, pericarditis, aortic dissection, pulmonary embolism, pulmonary hypertension, hypertensive emergency, heart failure, constrictive pericarditis, tamponade, myocarditis, endocarditis, hypertrophic cardiomyopathy, mitral valve prolapse, aortic stenosis, aortic regurgitation, mitral regurgitation, tricuspid regurgitation, pulmonic stenosis, pulmonic regurgitation, syncope, presyncope, chest pain of cardiac origin, anxiety/panic disorder with cardiac-like symptoms





PLAN:

Investigations:

- 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

Treatments:

- 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

Further care:

- 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

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