Reference no: EM133074208

Case study

A 56-year-old man presents to the emergency department (ED) with a complaint of chest pain that began 60 minutes earlier and has not resolved. He states he has never had a heart attack before. He is a current smoker and has smoked 1 pack per day for 30 years. He has been having intermittent episodes of chest pain off and on for the last 4 months, but today was the first time that the chest pain persisted prompting him to visit the ED.

The patient initially noticed the chest pain a few months ago while walking or climbing stairs. These episodes would resolve a few minutes after stopping and resting. In the last month, he has noticed that less effort would bring on the pain and has even noticed it while sitting watching television. Today, he awoke from sleep with chest pain that did not go away and so he came to the ED. Today's pain is a diffuse precordial burning and pressure that radiates to both shoulders and arms. Prior episodes have been felt in his lower jaw. Right now he feels nauseous and as if he cannot quite catch his breath; this is something he has never felt previously. On further questioning, some time ago, he was told his cholesterol was high but he never sought further follow-up. He has been under a great deal of stress at work during the last few months.

Question 1: List 3 differential diagnoses in order.

Question 2: Subjective / objective data from case, that is, the pertinent positives and negatives supporting diagnoses.

Question 3: What is the complete diagnostic plan and rational.

Question 4: Use references within the last five years