N512-19A Module Two: Cardiovascular Disease Across the Life Span Discussion
N512-19A Module Two: Cardiovascular Disease Across the Life Span Discussion
N512-19A Module Two: Cardiovascular Disease Across the Life Span Discussion
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Discussion 2
Jackie Johnson, a 35 y.o. African-American, married female, advertising executive, presents to the emergency department with complaints of chest pain. N512-19A Module Two: Cardiovascular Disease Across the Life Span Discussion. The pain is described as 8 on a scale ranging from 1 to 10, retrosternal, and sharp in nature. It radiates to the back, is worse with taking a deep breath, and is improved by leaning forward. On review of systems, she has noted a “flulike illness” over the last several days, including fever, rhinorrhea, and cough. She has no medical history and is taking no medications. She denies tobacco, alcohol, or drug use. On physical examination, she appears in moderate distress from pain, with a blood pressure of 125/85 mm Hg, heart rate 105 bpm, respiratory rate 18/min, and oxygen saturation of 98% on room air. She is currently afebrile. Her head and neck examination is notable for clear mucus in the nasal passages and a mildly erythematous oropharynx. The neck is supple, with shotty anterior cervical lymphadenopathy. The chest is clear to auscultation. Jugular veins are not distended. Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal.
In this discussion:
- Provide and discuss this patient’s likely diagnosis with your colleagues. Why do you support this “likely” diagnosis?
- Discuss your differential diagnoses clinical reasoning. Why do you support this list of potential differential diagnoses?
- Provide and discuss what the most common causes of this disease are, and which is most likely in this patient?
- Identify the pathophysiologic mechanism for her chest pain.
- Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports.
Support your discussion with citations from the external literature and your textbook.
Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.
Sample Solution Approach
Discussion 2
J.J.’s probable diagnosis is pericarditis and is likely related to the viral symptoms she experienced earlier this week. The symptoms that suggest pericarditis are sharp retrosternal chest pain that worsens with lying down, improves sitting forward and increases with deep breathing or coughing; along with concomitant flu-like symptoms (fever, cough, sore throat and runny nose) (Spangler & Gentlesk, 2019). Examination of her cardiac system did note a three-component high-pitched squeaking sound and tachycardia. To confirm the pericarditis, an electrocardiogram, chest x-ray, laboratory studies, and possibly an echocardiogram could be done (Spangler & Gentlesk, 2019).
Possible differential diagnoses are chest cartilage inflammation, a gastrointestinal disorder, a cardiac event, or a pulmonary embolism (Spangler & Gentlesk, 2019). The symptom of chest pain can be found in most of these conditions and so could the sign of tachycardia. Changes found on ECG’s, radiographic studies, laboratory markers and any cardiac ultrasounds could assist in ruling out any these diagnoses (Spangler & Gentlesk, 2019).
The common causes of pericarditis are infectious, injurious, metabolic, neoplastic, idiopathic or collagen vascular in nature, with the most common being viral nature. Kusomuto (2019) suggested that idiopathic pericarditis is likely viral in nature as well. J.J.’s pericarditis probably viral as evidenced by her flu-like symptoms.
The pathophysiologic mechanism behind her chest pain is the acute inflammation of the pericardial cells and the pleuritic cells surrounding it. The increased permeability along with an increase in leukocytes and fibrin create effusion and adhesions which can restrict and causing rubbing of pericardial surfaces which in turn cause pain in the chest region (Kusomuto, 2019).
If J.J.’s pericarditis has been diagnosed as uncomplicated and viral in nature, her plan of care for at home would involve activity reduction, supportive care, and symptom management. Anti-inflammatory drugs are main medications of choice, with a one to two-week regimen specifically of Non-Steroidal Anti-inflammatory drugs to combat the inflammatory process and any mild to moderate pain (Spangler &Gentlesk, 2019). Spangler & Gentlesk (2019) also mentions studies that uses colchicine as adjuvant for inflammation management and prevention of future pericarditis episodes.
References
Kusomuto, F.M. (2019) Cardiovascular disorders: Heart disease. In McPhee, S. J., & Hammer, G. D. (Eds.), Pathophysiology of disease: An introduction to clinical medicine (8th ed., pp. 405-459). McGraw-Hill Education LLC.
Spangler, S. & Gentlesk, P.J. (2019, November 10) Acute pericarditis. Retrieved July 25, 2020
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In reply to Tammie
Re: Tammie Discussion 2 – N512-19A Module Two: Cardiovascular Disease Across the Life Span Discussion
Having a patient with chest pain can be a very scary situation for not only a patient but also providers. Chest pain can be caused by many different issues and some can be life threatening such as you mentioned a cardiac event, pulmonary embolism, or even pericarditis can become life threatening if it turns into tamponade. Then there is non life threatening like gastrointestinal disorder or cartilage inflammation. Based on J. J’s symptoms, including recent flu-like symptoms, the most likely cause of her pericarditis is a viral infection. However, tuberculosis is another cause of pericarditis, according to Center for Disease Control [CDC] (2019), an African American population in the United States continue to have a high burden of Tuberculosis (CDC, 2019). Given she has no other history this is probably an unlikely cause and could be ruled out on a chest x-ray. You had mentioned ECG’s changes and laboratory markers could assist in ruling out other diagnoses, I will tell you from personal experience (Cath lab nurse here lol) changes on an ECG and increased laboratory markers in a patient with pericarditis can also have the same resemblance as coronary artery disease. One of the ways I have seen physicians decipher between pericarditis and coronary disease is to perform an echocardiogram (ECHO). An ECHO can show wall motion abnormalities consistent with coronary disease.Great post!
AR
Reference
Centers for Disease Control. (17 May 2019). Tuberculosis: African American community. https://www.cdc.gov/tb/topic/populations/tbinafricanamericans/default.htm
249 words
In reply to Tammie Vandenberg
Re: Tammie Discussion 2
229 words N512-19A Module Two: Cardiovascular Disease Across the Life Span Discussion
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