Please use APA 7th edition and 3 references dated less than 2 years
A recent patient I had during my clinical experience was a 55-year-old male who came into the office with chest pain lasting 8 hours. His pain was described as crushing, severe, chest pain that radiated to his right arm. The patient was also diaphoretic and pale in appearance. His 12 initial lead EKG showed a heart rate of 102, low voltage QRS, sinus rhythm, a first-degree AV block, and an ongoing anterior wall infarct. While the ECG in the setting of NSTE-ACS may be normal in more than 30% of patients, characteristic abnormalities include ST-segment depression, transient ST-segment elevation, and T-wave changes (Collet et al., 2021).
The patient’s vital signs were 180/97, 95, and O2 92%. His lung exam showed no alterations. He did have a history of hypertension and hyperlipidemia and was a smoker. Aspirin was given in the office and the paramedics delivered 5 mg of metoprolol on the way to the hospital according to hospital records.
The patient was hesitant over the phone when he made a primary care visit, we urged the patient to go to the Emergency Room stating repeatedly the consequences of his decision. He wanted only to be seen in the office. After all, he finally agreed to go to the Emergency room after we did what interventions we could do in the office.
Chest pain is not a common occurrence in primary care but it does occur once in a while. Therefore, clinicians must raise red flags when appropriate, have low thresholds for referring patients to EMS, and know when it is appropriate to send them to EMS. According to a study by Andersson et al., (2018), a total of 688 patients with MI, 519 men and 169 women, with a mean age of 66 years, one in five people contacted primary care instead of the recommended EMS, and 94% of these patients experienced cardinal symptoms of an acute MI; i.e., chest pain, and/or radiating pain in the arms, and/or cold sweat.
Primary care providers must rely primarily on history taking, physical exams, and past experiences to make a diagnosis or establish the need to have the patient be seen by EMS (Harskamp et al., 2019). The common working differentials include less frequent but urgent diagnoses of chest pain, such as acute coronary syndrome, or pulmonary embolism, from more common but less urgent diagnoses (such as gastroesophageal reflux, musculoskeletal pain, or anxiety) ( Harskamp et al., 2019).
Chronic care management may be a number of interventions at this patient’s hospital follow-up visit. A few examples are heart failure (HF) management and education, labs to assess kidney function while on Lisinopril, or medication management. The patient may also need a referral to a cardiologist or a referral or a nutritionist to discuss heart-friendly diets. He may also need to be on cardiac drugs for life that may need ongoing labs to assess the metabolic functioning of other organs, such as the kidneys. The patient may also need to have ongoing discussions about smoking cessation and encouragement to stop as well. All in all, the medical care provided at the hospital, the hospital discharge report, and the patient’s needs will all help dictate what he needs for chronic care management.
Andersson, P. O., Lawesson, S. S., Karlsson, J. E., Nilsson, S., Thylén, I., & SymTime Study Group (2018). Characteristics of patients with acute myocardial infarction contacting primary healthcare before hospitalization: a cross-sectional study. BMC family practice, 19(1), 167. https://doi.org/10.1186/s12875-018-0849-8
Collet, J. P., Thiele, H., Barbato, E., Barthélémy, O., Bauersachs, J., Bhatt, D. L., Dendale, P., Dorobantu, M., Edvardsen, T., Folliguet, T., Gale, C. P., Gilard, M., Jobs, A., Jüni, P., Lambrinou, E., Lewis, B. S., Mehilli, J., Meliga, E., Merkely, B., Mueller, C., … ESC Scientific Document Group (2021). 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European heart journal, 42(14), 1289–1367. https://doi.org/10.1093/eurheartj/ehaa575
Harskamp, R. E., Laeven, S. C., Himmelreich, J. C., Lucassen, W. A. M., & van Weert, H. C. P. M. (2019). Chest pain in general practice: a systematic review of prediction rules. BMJ open, 9(2), e027081. https://doi.org/10.1136/bmjopen-2018-027081