Initial Differential Diagnoses
According to Miguel’s symptoms and complaints, he was likely to have heart problems such as heart attacks. Taking into consideration the type of pain that he had, we can also suggest that he had a cardiac neurosis. What is more, it could be intercostal neuralgia that is also characterized by severe pain in the lower chest.
As for the heart attack, it usually occurs when the blood flow to the heart is blocked. As a result, the heart muscle dies because of a low blood supply. The second disease, cardiac neurosis, occurs due to malfunctioning of the nervous system. The severe pain in the chest usually appears after some serious emotional upset. As for intercostal neuralgia, it is connected to the serious damage of intercostal nerves. It can develop as a result of earlier inflammatory processes or contagious diseases.
Specific History Questions
To be sure that it is a heart attack, I would ask the patient if he feels dizziness or breath problems as the combination of these symptoms with severe chest pain is usually a strong signal of a heart attack. To be sure that the patient has cardiac neurosis, I would ask if he has choking spells and a strong sense of panic as these symptoms are very common for the disease. To make sure that he suffers from intercostal neuralgia, I would ask him if his pain becomes stronger when he moves and if he has paraesthesia; these symptoms usually indicate nerve damage.
Specific Components of the Physical Exam
- Heart attack: examine skin coverage, if there is a cold sweat if the patient has gummy ankles and rapid pulse.
- Cardiac neurosis: measure a body temperature (it is usually high), ensure if the patient has a sense of shock.
- Intercostal neuralgia: perform the palpation of intercostal space (it should cause severe pain).
Expected History and Physical Exam Findings for One Diagnosis
History and physical exam findings predictive of the heart attack involve assessment of risk factors including smoking, diabetes, or family history of the disease. It is also necessary to find out that the patient has had episodes of chest pain before, breath shortness, and chest discomfort.
To rule out the chosen diagnosis, I would use an ECG to find signs of current or previous heart attacks (Nordqvist, 2016, para. 10). I would also conduct the blood test to find out if there is an increased amount of proteins in the blood. When the heart muscle dies, they are released into the blood.
Many medications can be taken but first of all, I would prescribe 160-320 mg of aspirin daily, PO (Dalen, 2011, p. 198).
Recommendations to the Patient
First of all, at least one week after the heart attack the patient should be kept in the hospital as there is a danger of complications. Then, I will explain to the patient that he has to be on a diet, he should not eat food rich in calories, farinaceous dishes, and very salty food (Williams & Thompson, 2014, p.1188). What is more, I will recommend him to walk slowly about 20 minutes a day, and visit a doctor regularly. Besides, I will provide him with all the necessary information concerning the disease so that he would be able to get essential help in case of further heart attacks.
Dalen, J. E. (2011). Aspirin to prevent heart attack and stroke: What’s the right dose? The American journal of medicine, 119(3), 198-202.
Nordqvist, C. (2016). Heart attack: Symptoms, diagnosis, and treatments. MNT. Web.
Williams, P. T., & Thompson, P. D. (2014). Increased cardiovascular disease mortality associated with excessive exercise in heart attack survivors. Mayo Clinic Proceedings, 89(9), 1187-1194.