Chest Pain

CC:  “Chest Pain”


Don't use plagiarized sources. Get Your Custom Essay on
Chest Pain
Just from $13/Page
Order Essay


Patient presents with complaints of chest pain that awoke her from sleep last night. Patient describes the pain as mid-sternal “squeezing, and pressure” with “tightness” radiating to her back. Patient reports that the pain was accompanied by diaphoresis. Episode lasted approximately 15-20 minutes at which time the pain spontaneously resolved. Reports she has experienced some intermittent attacks of chest pain and tightness approximately 2-3 times over the last six months, but that previous episodes were only a couple of minutes in duration, with less severe pain, and occurred while either walking the neighborhood or when she was “emotional”. Pain with prior episodes seemed to be relieved by rest. Pt. did not seek medical attention after previous episodes. Patient was unable to identify any alleviating factors associated with this episode. Aggravating factors with previous episodes included physical exertion, after eating a large meal (fried chicken), and emotional distress, but patient was not able to identify any precipitation or aggravating factors associated with last night’s chest pain. Patient denies experiencing any syncope, dizziness, shortness of breath, changes in pain with respirations, and cough. Patient denies change in diet or any unusual foods that evening. Patient denies headache. Denies vomiting but had some mild nausea last night.



Positive for hypertension, hyperlipidemia, arthritis, uterine fibroids and GERD.  Denies history of asthma, allergies, cancer, diabetes, stroke, seizure disorder, myocardial infarction, bleeding disorders, urinary disorders, and depression.

Surgical history: Hysterectomy at age 50 r/t uterine fibroids

Psychiatric: Denies

Social History: Tobacco: 1.5 PPD smoker (should have asked for how many years in order to calculate pack years) ETOH use: occasional social drinking; drinks beer and liquor average 1-2 drinks per sitting Denies illicit drug use. Participates in monthly bowling league, but does not engage in regular aerobic or weight bearing exercises. Tries to eat a healthy diet.

Family History: Father died of heart attack at age 50. Mother 85 y/o is living, independent and in good health. Siblings both in good health. Sister had cholecystectomy at age 45. Denies family history of cancer, diabetes, stroke, kidney disease, neurologic disorders, stroke, bleeding disorders and mental illness.

Preventative Care: Immunizations: Influenza Fall 2014; Tetanus 2013

Current medications: RX: 1. HCTZ 25 mg PO daily

  1. Lipitor 20 mg PO daily
  2. Omeprazole 20 mg PO daily
  3. OTC: Denies




GEN: Denies pain at this time, fatigue, fever, or weight changes.

HEENT: Denies HA, dizziness, sore throat, changes in vision or hearing. Does admit to mild burning in throat and occasional “sour” taste in mouth.

NECK: Denies neck pain, hoarseness, or difficulty swallowing.

CHEST: Denis cough, shortness of breath with exertion or at rest. Denies pain with inspiration or expiration.

CV: See details in HPI.

GI: Denies vomiting or change in bowel habits, but admits to nausea. Admits to recent belching. Has occasional epigastric pain.

GU: Denies dysuria, incontinence, or changes in voiding pattern.

MUSC: Denies joint pain or swelling.

NEURO: Denis headache, syncope, dizziness, muscle weakness or ataxia.

PV: Denies any extremity swelling or changes in temperature.

PSYC: Denies any changes in mentation or mood. Denies depression.



Temperature: 98.4 (oral), Pulse 90, Respirations 16, BP 160/94 Height: 68in. Weight: 201 lbs.

Waist Circumference: 40 inches BMI: 30.6 (obese);

BP recheck: 128/78 (lying), 132/82 (sitting)

Pleasant well, groomed female in no acute distress.


HEENT: Facial features symmetrical. Uvula midline, pharynx without erythema, edema or exudate. No odor noted. Pupils round reactive to light. No scleroicteris. Moist mucous membranes. TMs intact with good light reflex, canals clear. Nares patent. Turbinates moist/pink. Whispered word perceived at 5 feet. Vision 20/25 OU, OS, OD. No tenderness with palpation.


SKIN: Without lesions notes; turgor good; Warm & dry to touch. Hair distribution, texture, and quantity unremarkable. Nail beds pink.


NECK: Supple, non-tender, trachea midline. Thyroid non-enlarged, non-tender, without palpable mass or nodule. No lymphadenopathy. Full range of motion.


CHEST: Thorax without distortion, non-tender with symmetric expansion. Respiration regular and unlabored, without cough. Tactile fremitus equal bilaterally and greater in upper lung fields than lower.  Breath sounds clear with adventitious sounds. All lung fields with resonant percussion tones. AP ratio 2:1. No egophony, whispered pectoriloquy or bronchophony noted.


CV: Apical pulse not visible. Apical pulse palpable, approximately 1 cm at midclavicular line 5th ICS without thrill, lift or heave. RRR, Crisp S1 and S2 without extra heart sounds, murmur, rub, or gallop. NO apparent JVD. Bilateral carotid upstrokes brisk, without bruits.


EXTREMITIES: No clubbing or edema. No deformities noted. FROM actively and passively. No motor deficits.


ABDOMEN: Abdomen round, soft, and non-tender without rash, palpable mass or organomegaly. Active bowel sounds x4. Tympany over most quadrants with scattered areas of dullness noted upon percussion. Mild tenderness with palpation over the epigastric area and the RUQ. Lower supra-pubic surgical scar. No CVA tenderness.


PERIPHERAL VASCULAR: Skin pink, warm and dry and well perfused without edema, rash, or lesion. Nailbeds pink with <2 sec. capillary refill. No tropic skin changes or stasis changes noted. No abdominal bruits. 2 + dorsalis pedis pulses and radial pulses bilaterally.


NEURO: Patient alert, oriented, and appropriate. Moves all extremities well. Speech fluent and words are clear. Pt is coherent; cognition and insight appear intact. Strength 5/5 bilateral upper and lower extremities. Deep tendon reflexes 2+ throughout. Romberg normal, gait normal. Sensation equal to light touch. Distinguishes sharp-dull stimuli. CN I-XII intact:

I: Distinguishes smell of alcohol swab.

II: Visual Acuity- 20/20 with pocket screener, both eyes. Visual Fields- intact in all fields

II and III: PERRLA; peripheral vision intact

III, IV, VI: EOM- intact

V: Light Touch Face- in all 3 divisions of V; opening jaw strength normal

VII: Wrinkle Forehead, Close Eyes, Show Teeth; symmetrical

VIII:Whispered word at 5 feet heard

 IX & X:Swallowing intact; Uvula rise and fall with “AHHHH”

XI: Shrug Shoulders

XII: Protrude Tongue- midline protrusion



  1. Read the case scenario.
  2. Develop a differential list of the three most likely diagnoses. List these in priority of which you think is the most likely first.
  3. Write an explanation of the reasoning in choosing the most likely diagnosis.
    4. Write an explanation of the reasoning in choosing the two alternative diagnosis.

It must be in APA 7 , and must be at least 500 words.

You must have 2 supported sources from the literature in your initial response. Please note that APA requirements apply to all discussions and make sure to follow the discussion rubric.

Bullets 1-4 listed above are needed for the “initial post” of the discussion,




















The Homework College
Calculate your paper price
Pages (550 words)
Approximate price: -

Why Work with Us

Top Quality and Well-Researched Papers

We ensure that our writers and editors work within the work guidelines and follow all paper instructions to the letter. When placing an order, you choose the academic field and expert level (high school, college, university, or professional). Our team then assigns your paper to a writer with a respective qualification or degree to ensure that you receive quality work.

Professional and Experienced Academic Writers

We employ professional writers with more than two years of experience in academic and business writing. Most of our writers and editors are native English speakers to ensure quality and professional work. We are confident that our team of professional writers can handle all types of business and academic writing work.

Free Unlimited Revisions

We provide a free revision service for all orders. If you feel that our writers missed something, you can request a revision of your paper at no additional cost. When we deliver your work, you have seven days to go through it and request a revision or modification if you are not satisfied. You can also contact our support team directly for any clarifications and queries on revision.

Prompt Delivery and 100% Money-Back-Guarantee

We ensure that all papers are delivered on time. In case we need more time to master your paper requirements and deliver quality work, we may contact you and discuss a deadline extension. If a deadline extension is not feasible, depending on the work and submission deadlines, we guarantee a 100% refund.

Original & Confidential

To ensure that we deliver plagiarism-free work, we use various writing and plagiarism checking tools. Our professional editors' team carefully goes through all work and references used in papers to ensure proper referencing and that original work has been done. We also guarantee confidentiality in all the services that we provide.

24/7 Customer Support

Our support team is available round the clock for any customer queries and communication. We guarantee 24/7 customer support and assistance. Feel free to contact us at any time of day for questions and follow-ups.

Try it now!

Calculate the price of your order

Total price:

How it works?

Follow these simple steps to get your paper done

Place your order

Fill in the order form and provide all details of your assignment.

Proceed with the payment

Choose the payment system that suits you most.

Receive the final file

Once your paper is ready, we will email it to you.

Our Services

You do not have to spend sleepless nights worrying about your paper. We got you covered. We offer all kinds of writing services.


Essay Writing Service

Regardless of the type of academic paper you need and its urgency, we have writers on call ready to work on your paper. Feel free to choose the field, educational level, and type of paper you want, and we will deliver it at an affordable price. We are here for all your academic and business paper needs. With our round the clock service, we guarantee that you will receive your work on time.


Admission Essays & Business Writing Help

Admission essays are written by students wishing to join a college, graduate school or university, as applications for enrollment. We guarantee quality admission essays and business papers with our professional writing and customer care support services.


Editing Support

We have experienced academic writers and editors who are on standby to make all the necessary changed to your paper at your request. We ensure that your paper is polished and appropriately formatted (APA, Harvard, Chicago/Turabian, MLA formats) before it is delivered.


Revision Support

We provide revision support, where you can request a revision of a delivered paper if you feel that it can be improved or repolished. Your paper is checked by an experienced writer or editor for revamping and improvement upon a revision request. Revision service is free, and you can use it as many times as you wish until you are satisfied with your paper.