Lifestyle Issues in Cardiac Health
Chest Pain
The physician gives Mr. Fowler considerable positive feedback and praises his efforts and progress. After discussion of advantages and disadvantages, he decides that he will take an aspirin tablet once a day. The physician makes an appointment to see him again in six months. Mr. Fowler does not keep this appointment and does not see the physician again for two years.
At age 49 years, Mr. Fowler presents to the local emergency department with a one-hour history of severe chest pain. The pain developed while he was eating breakfast in a restaurant. He drove home from the restaurant and lay in bed for a brief period waiting for the pain to subside. However, the severity of the pain increased, and he noted radiation of the pain into his neck and left arm. He contacted a neighbor who brought him to the emergency department. He describes the pain as a very oppressive heavy pressure in the center of his chest. Since the onset of the pain, he has experienced some difficulty breathing and generalized weakness and sweating. On several occasions, he has felt like vomiting but has not done so. He denies previous episodes of chest pain.
Questions
- What is the differential diagnosis?
- What are the next steps in the management?