I human case study -steven van dyke,36 years- old Caucasian male cc:smoker with chest tightness
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I Human Case Study -steven Van Dyke,36 Years- Old
I human case study -steven van dyke,36 years- old Caucasian
male cc:smoker with chest tightness
I human case study -steven van dyke,36 years- old Caucasian
male cc:smoker with chest tightness
I human case study -steven van dyke,36 years- old Caucasian
male cc:smoker with chest tightness
I ...
I human case study -steven van dyke,36 years- old Caucasian
male cc:smoker with chest tightness
Steven Van Dyke is a 36-year-old Caucasian male
smoker who presents to the ED following the acute onset
of nonradiating, nonreproducible chest tightness of >20
minutes duration, symptoms beginning while he was
watching TV. He complains of associated palpitations,
shortness of breath, choking sensation, dizziness,
nausea, sweating, and “fear of having a heart attack.”
He reports a 1-month history of similar episodes lasting
5-20 minutes, and now increasing in intensity over the
past week. The first episode happened while exercising;
subsequent episodes occurred during work-related
meetings. This is the first episode occurring at rest
outside of the work setting. PMH is significant only for
childhood asthma; he denies any history of psychiatric
disease. The patient’s father died 2 years ago at age 62
due to an MI. PE reveals an anxious-appearing young
male with fidgeting of hands and legs. He is tachycardic
and takes deep breaths between speaking in phrases. The
cardiopulmonary and neurologic exams are otherwise
normal.
Primary Diagnosis:
Panic Disorder: characterized by episodic, unexpected
panic attacks that occur without a clear trigger
(American Psychiatric Association, 2013). Attacks have a
, rapid onset of intense fear with at least four of the
physical and psychological symptoms, such as
palpitations, sweating, trembling/shaking, sensations of
shortness of breath, feelings of choking, chest pain or
discomfort, nausea, dizziness, or fear of losing control or
dying (Locke, Kirst, & Shultz, 2015). The disorder is not
caused by the physiological effects of a substance or
undiagnosed medical condition.
Acute Coronary Syndrome: symptoms of chest pain,
referred chest pain, dyspnea, nausea, vomiting, light-
headedness, and diaphoresis. Chest pain is commonly the
first symptom that describes it as sudden, severe, heavy,
and crushing sensation. Physical examination reveals an
increase in heart rate and blood pressure, abnormal extra
heart sounds, pulmonary findings of congestion, or
peripheral vasoconstriction (Huether & McCance, 2012,
p. 607). Typical angina is described as substernal pain,
occurs on exertion, and is relieved with rest (Achar,
Kundu, & Norcross, 2005). Chest pain that occurs
suddenly at rest or in a young patient may suggest acute
coronary vasospasm, which occurs in Prinzmetal’s
angina or cocaine or methamphetamine use (Achar et al.,
2005).
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