mpprc chest pain final final

8/6/2019 MPPRC Chest Pain Final Final

1/14

AN APPROACH TO A PATIENTAN APPROACH TO A PATIENT

WITH CHEST PAINWITH CHEST PAIN

Group 3Group 3

SamsonSamson SarmientoSarmiento

1


2/14

Medical History

BC a 63 y/o male, policeman, Filipino

Chief Complaint Chest Pain

History of Present Illness

7 monthsChest heaviness 4/10

Chest heaviness 6/102 weeks

Admission

Numbness on left arm

2

Santos, Hernan Haron II


3/14

PAST MEDICAL HISTORY

(+) Hypertension x 15 years 200/100 mmHg (highest BP)

160/90 mmHg (Regular BP)

Irregular intake of metoprolol (50 mg)

(+) Diabetes Mellitus x 10 years Irregular intake of glipizide

(+) polyuria, polydypsia, polyphagia

No previous surgical illness requiring hospitalization

3



4/14

FAMILY HISTORY

Mother: (+) DM

Father: (+) HPN

Sudden Death at 40 y/o

Sister: (+) HPN

Brother: (+) HPN

(+) DM

s/p CABG (45 y/o)

PERSONAL and SOCIAL

HISTORY Police Officer (Head CPD Manila)

40 Pack years

Drinks 3 bottles of beer a day 3x a

week since 30 years old. Fond of eating pork, beef and eggs

No regular exercise

No illicit drugs

4



5/14

Review of Systems

General No significant weight loss

Neurological No loss of consciousness, noheadache

HEENT No blurring of vision, no eardischarge, no tinnitus

Respiratory No cough, no colds, no dyspnea

Gastrointestinal No epigastric pain, no diarrhea,no constipation, no melena, nohematochezia

5



6/14

Review of Systems

Genitourinary No dysuria, no frequency, no

urgency, no pollakuria

Endocrine (+)polyuria, polydipsia,polyphagia

No heat or cold intolerance

MusculoskeletalN

o joint pains

6



7/14

Physical Examination

Conscious, coherent, obese, not in CP distress

BP = 180/90 PR = 100/min, regular

RR = 19/min Temp. = 37 degrees Celsius

Height = 1.5 meters Weight = 70 kilogramsBMI = 31 (class I obesity)

Pink palpebral conjunctiva, anicteric sclera

No nasal no aural discharge, moist buccal mucosa

7



8/14


No neck masses, JVP 4.5cm at 45 degrees angle

Carotid artery pulse showed rapid upstroke,

gradual downstroke, (-) carotid bruit

Symmetrical chest expansion, no retractions,resonant

Unimpaired transmission of vocal and tactilestimuli, clear breath sounds

8



9/14


Adynamic precordium, apex beat at 6th L ICS AAL

S1>S2 apex, S2>S1 base, (-)S3 & S4, no heaves, no

thrills, no murmur

Flabby abdomen, normoactive bowel sounds,tympanitic, non-tender

Liver dullness 10 cm, Traubes space not obliterated

No pedal edema, pulses ++ on all extremities

9



10/14

Missing Information

No laboratory findings for:

blood glucose levels Lipid profile (cholesterol, VLDL, LDL, HDL,

triglycerides)

10



11/14

SALIENT FEATURESSUBJECTIVESUBJECTIVE

63 y/o Filipino male, policeman

Chest heaviness

Numbness on left arm

(+) HPN and (+) DM

Irregular intake of Metoprolol andGlipizide

(+) polyuria, polydypsia, polyphagia

(+) Family Hx of HPN

High fat diet with no regular exercise

Smoker

(-) cough, colds, or dyspnea No significant GI findings

OBJECTIVEOBJECTIVE

BMI = 31

Consious

Coherent

BP - 180/90, PR-100 bpm

JVP 4.5cm at 45 degree angle

Carotid artery rapid upstoke, gradualdownstroke

Apex beat at 6th LICS AAL

(-) S3,S4

No edema

S 1 > S2 apex, S2


12/14

Chest PainChest Pain

Noxious stimuli that is conveyed byNoxious stimuli that is conveyed by

somatosensory and/or viscerosensory nervessomatosensory and/or viscerosensory nerves

that is perceived as pain in the anterior chestthat is perceived as pain in the anterior chest

wall that may radiate to the arms, neck, or jawwall that may radiate to the arms, neck, or jaw

Symptom common toSymptom common to

many diseases in themany diseases in thethoracic and abdominalthoracic and abdominal

visceraviscera

Clinical Anatomy by Regions 8th edition 12



13/14


14/14

Onset:Onset: ExertionExertion RestRest

EmotionalEmotional

experienceexperience

Eating or coughingEating or coughing

Extreme temperatureExtreme temperature TraumaTrauma

Location:Location: RadiatingRadiating

oo

ArmsArmsoo NeckNeck

oo JawsJaws

oo TeethTeeth

oo ScapulaScapula

SubsternalSubsternal

Severity: Interferes withactivity

Disrupts sleep

mpprc chest pain final final

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