How would you diagnose and manage this 17-year-old male whose symptoms include palpitations, fever, and malaise?
Fever, chest pain and palpitations are three of the most common symptoms among patients who address emergency departments (ED) (Perkins & Liang, 2017). For this reason, there is a wide array of possible etiologies related to differential diagnosis. It is crucial to determine the right cause for the development of these health problems. Regarding the case, pain in the chest found in a 17-year-old male may indicate problems with the heart, lungs, esophagus, upper GI tract, skin, ribs, etc. (Perkins & Liang, 2017). For this reason, it is crucial to analyze symptoms and exclude an inappropriate diagnosis. Considering factors like extra beats and tachycardia, a specialist could narrow the list of diagnoses to viral myocarditis or acute pericarditis as the only possible diseases resulting in the appearance of the following symptoms.
Which diagnostic studies would you recommend for this patient? Include the rationale for ALL diagnostics and Labs?
To determine the final diagnosis, several diagnostic studies are recommended. First, a complete blood count to discover the presence of inflammatory processes or other health problems is required (Friedman & Alexander, 2014). Additionally, echocardiography as the primary tool to examine the state of the patients heart and its functioning is needed. It could also help to exclude other probable cases of heart failure (Friedman & Alexander, 2014). Therefore, the patient should be recommended to have antimycotic scintigraphy to discover the presence or absence of myocardial inflammation. A specialist could also perform CBC and O2 saturation assessments to determine the state of the patient and how the heart functions at the moment (Chappell, 2013). CT or MRI could help to admit pericardial thickening which is one of the signs of the disease (Spangler, 2016). Finally, rheumatologic screening along with electrocardiography might be needed to acquire a complete picture and exclude any other diagnoses characterized by similar symptoms (Spangler, 2016). These are the central diagnostic studies that should be prescribed to the patient.
What physical exam findings and diagnostic results would be concerning to you and why? What would be three differentials in this case? Identify additional life-threatening diagnoses that must be considered when a patient presents with acute chest pain.
First, low blood pressure (100/70 mmHg) could be considered the first evidence of acute pericarditis as it is one of the basic symptoms. Second, high temperature (102,2F) indicates the presence of a particular inflammatory process which is another sign of the disease. Increased respiratory rate (24 bpm) also indicates the critical state of the patient. Finally, the patients pulse (140 bpm) is too high and might state as pericarditis. However, it is crucial to understand physical findings correctly as there are several differentials peculiar to this case. These are viral myocarditis and acute pericarditis, and pericardial effusion (Tang, 2016). At the same time, the complexity of the symptoms and their character might indicate life-threatening diagnoses that should be taken into account by a specialist. These are myocardial infarction, cardiac tamponade, and chronic constrictive pericarditis. These remain extremely dangerous for the patient and should be avoided to ensure recovery.
What is the treatment (including rationale) for Robert and education for the family?
For patients with acute pericarditis nonsteroidal anti-inflammatory drugs(NSAIDs) should be prescribed to reduce pain in the chest, eliminate the area of inflammation, and stabilize fever (Norrid & Oliphant, 2014). For this reason, ibuprofen intravenously 1200-1800 md/d because of the low risk of side effects should be used (Spangler, 2017). The treatment should last from 7 to 14 days until the state of the patient has been improved. Next two weeks the patient should be monitored to avoid reoccurrence of the disease. The family should be educated about the main symptoms of pericarditis and possible complications. Additionally, the patient and his close people should be provided with information regarding the lifestyle and possible treatment of the disease. If all recommendations are followed, the complete recovery could be guaranteed.
References
Chappell, J. (2013). Pericarditis/myocarditis, infectious. Web.
Friedman, K., & Alexander, M. (2014). Chest pain and syncope in children: A practical approach to the diagnosis of cardiac disease. The Journal of Pediatrics, 163(3), 896-901, Web.
Norrid, S., & Oliphant, C. (2014). Colchicine for the treatment of acute and recurrent pericarditis. Annals of Pharmacotherapy, 48(8), 1050-1054. Web.
Perkins, J., & Liang, S. (2017). Fever and chest pain. Web.
Spangler, S. (2016). Acute pericarditis. Web.
Spangler, S. (2017). Acute pericarditis: Treatment & management. Web.
Tang, W. (2016). Myocarditis. Web.