Posted: March 28th, 2023

Case Study Analysis: A 60-year-old Female with Chest Pain

Case Study Analysis: A 60-year-old Female with Chest Pain

Introduction
Chest pain is a common presentation in the emergency department (ED) and can be a symptom of a range of underlying medical conditions. In this case study, we analyze the case of a 60-year-old female presenting to the ED with chest pain. We will discuss the patient’s clinical history, physical examination findings, and diagnostic workup, followed by a differential diagnosis and management plan.

Clinical History
The patient is a 60-year-old female with a past medical history of hypertension, hyperlipidemia, and hypothyroidism. She presents to the ED with chest pain, which started while she was gardening in her backyard. She describes the pain as a pressure-like sensation in the center of her chest that radiates to her left arm. The pain has been ongoing for the past 30 minutes, and she rates it as an 8 out of 10 in severity. She denies any shortness of breath, nausea, vomiting, or diaphoresis.

Physical Examination
On physical examination, the patient appears uncomfortable and is clutching her chest. Her vital signs are within normal limits. Cardiovascular examination reveals regular rhythm, normal heart sounds, and no murmurs, rubs, or gallops. Lung examination is clear to auscultation bilaterally. Abdominal examination is unremarkable.

Diagnostic Workup
An electrocardiogram (ECG) is performed, which shows ST-segment elevation in leads II, III, and aVF, consistent with an inferior wall myocardial infarction (MI). A troponin level is drawn, and the result is elevated, further supporting the diagnosis of MI.

Differential Diagnosis
The patient’s presentation is consistent with an inferior wall MI, which is the most likely diagnosis given the ECG and elevated troponin level. Other potential causes of chest pain, such as pulmonary embolism, aortic dissection, and pneumothorax, should also be considered in the differential diagnosis.

Management Plan
The patient is started on aspirin, heparin, and nitroglycerin for the treatment of her MI. She is taken to the cardiac catheterization laboratory for emergent angiography and possible percutaneous coronary intervention (PCI). The patient is admitted to the cardiac care unit for further management and monitoring.

Conclusion
In conclusion, the case study of a 60-year-old female presenting to the ED with chest pain highlights the importance of prompt recognition, diagnosis, and management of acute coronary syndrome. In cases of chest pain, a thorough clinical history, physical examination, and diagnostic workup should be performed to determine the underlying cause. An ECG and troponin level should be obtained promptly in patients with suspected MI, and appropriate treatment, such as antiplatelet therapy, anticoagulation, and revascularization, should be initiated promptly.

References:

Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130(25):e344-e426.
Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Eur Heart J. 2012;33(20):2551-2567.
Newby LK, Jesse RL, Babb JD, et al. ACCF 2012 expert consensus document on practical clinical considerations in the interpretation of troponin elevations: a report of the American College of Cardiology Foundation task force on Clinical