In the case under consideration, the patient’s complaints included sharp chest pain that worsened with inspiration and movement and a non-productive cough. In emergency departments, acute chest pain is a frequent clinical syndrome in about six million patients annually (Foy, Liu, Davidson, Sciamanna, & Leslie, 2015). Its causes vary from tension pneumothorax to acute coronary syndrome. A thorough examination and attention to each detail are required to avoid poor patient outcomes. Several differential diagnoses can be given to a patient with chest pain, and appropriate diagnostics have to be identified.
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Taking into consideration the symptoms and complaints of the patient, the following different diagnoses may be given:
- Acute myocardial infarction. This condition of acute coronary syndrome occurs when damaged heart tissue leads to cell death. According to Bruno et al. (2015), about 25% of emergency patients with chest pain may have this disease. Additional signs include radiation into the arm(s) or shoulder and painful movements (Bruno et al., 2015). In this case, radiation to the base of the neck and problems during inspiration cannot be ignored.
- Pericarditis. It is an inflammation of the pericardial sac that is frequently observed in middle-aged patients and may lead to death in 1% of patients (Brown, Dingle, Brywczynski, McKinney, & Slovis, 2017). A tamponade is one of the dangerous outcomes if no treatment occurs in time. The age and chest pain are the warning signs of this disease.
- Pulmonary embolism. It is characterized by the obstruction of the pulmonary arteries and a thrombus in any part of the venous system (Brown et al., 2017). This condition is difficult to diagnose due to its varied presentation. The patient must be questioned about his recent travels or insignificant traumas.
- Heart failure. It happens when the heart muscle cannot properly pump blood and makes the heart weak. Two hours of pain turn out to be a good period for invasive diagnostic evaluation (Bruno et al., 2015). Chest pain and breathing problems are signs that should be mentioned.
- Tension pneumothorax. It is a pulmonary disease when air reaches the pleural space that is outside the lung (Brown et al., 2017). Tachycardia must be checked in patients during the examination. Sudden chest pain and cough are the symptoms of this condition, and the patient reports on both of them.
- Acute thoracic aortic dissection. A false lumen is created as a result of a tear in the innermost aortic layer (Brown et al., 2017). This problem is frequently observed in men with the history of hypertension, and its peculiar feature that it rarely radiates to the arm (Brown et al., 2017). Blood pressure in both arms must be checked, and the difference can be the sign. The gender of the patient, chest pain characterized as sharp, and cough are the main reasons for this diagnosis.
Diagnostics and Labs
In addition to electrocardiogram (ECG) that shows the condition of the heart and the work of muscles, it is necessary to order several additional tests and evaluate the patient’s condition. Blood must be checked for inflammatory markers, as well as the levels of proteins and enzymes that can be found in the heart muscle (Syyeda, Fatima, & Hyder, 2017). When the heart is damaged, there is a possibility of enzymes to leak within a certain period.
Computerized tomography (CT) scanning helps contrast the heart and observe the condition of blood vessels. Ultrasound and x-rays are effective in diagnosing pneumothorax and similar diseases that cause chest pain because of panic attacks (Bruno et al., 2015). A positive outcome in diagnosis starts with the differentiation between cardiovascular and pulmonary problems in patients.
The death of the patient is explained by the inability to identify a correct health problem and complete all diagnostic and laboratory tests. Viral pleurisy was diagnosed because of the presence of its two symptoms – chest pain and a cough – and normal ECG results. However, if the blood was tested for the level of enzymes in the laboratory, and CT scanning was taken, effective treatment and surgery could save the patient’s life.
Brown, A., Dingle, H. E., Brywczynski, J., McKinney, J., & Slovis, C. (2017). The five deadly causes of chest pain other than myocardial infarction. The Journal of Emergency Medical Services, 42(1). Web.
Bruno, R. R., Donner-Banzhoff, N., Söllner, W., Frieling, T., Müller, C., & Christ, M. (2015). The interdisciplinary management of acute chest pain. Deutsches Aerzteblatt Online, 112(45), 768-780. Web.
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Foy, A. J., Liu, G., Davidson, W. R., Sciamanna, C., & Leslie, D. L. (2015). Comparative effectiveness of diagnostic testing strategies in emergency department patients with chest pain: An analysis of downstream testing, interventions, and outcomes. JAMA Internal Medicine, 175(3), 428-436.
Syyeda, A., Fatima, J., & Hyder, A. M. (2017). Acute phase reactants and lipid profile in acute chest pain presentations: A multimarker approach. International Journal of Research in Medical Sciences, 4(8), 3336-3342.