Identify the pathophysiologic mechanism for her chest pain.

Posted: February 3rd, 2024

Jackie Johnson, a 35 y.o. African-American, married female advertising executive presents to the emergency department with complaints of chest pain. The pain is described as 8 on a scale ranging from 1 to 10, retrosternal, and sharp.

It radiates to the back, is worse with taking a deep breath, and is improved by leaning forward. On review of systems, she has noted a “flulike illness” over the last several days, including fever, rhinorrhea, and cough. She has no medical history and is taking no medications. She denies tobacco, alcohol, or drug use.

On physical examination, she appears in moderate distress from pain, with a blood pressure of 125/85 mm Hg, heart rate 105 bpm, respiratory rate 18/min, and oxygen saturation of 98% on room air.

She is currently afebrile. Her head and neck examination shows clear mucus in the nasal passages and a mildly erythematous oropharynx. The neck is supple, with shotty anterior cervical lymphadenopathy. The chest is clear to auscultation.

Jugular veins are not distended. Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal.

In this discussion:

  1. Provide and discuss this patient’s likely diagnosis with your colleagues. Why do you support this “likely” diagnosis?
  2. Discuss your differential diagnoses clinical reasoning. Why do you support this list of potential differential diagnoses?
  3. Provide and discuss what the most common causes of this disease are, and which is most likely in this patient?
  4. Identify the pathophysiologic mechanism for her chest pain.
  5. Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports.   

Support your discussion with citations from the external literature and your textbook. 

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