M.R. is a 56-year-old general contractor who is admitted to your telemetry unit directly from his internist'soffice with a diagnosis of chest pain
On report, you are informed that he has an intermittent 2-month
history of chest tightness with substernal burning that radiates through to the mid back off and on, in
a stabbing fashion. symptoms occur after a large meal; with heavy lifting at the construction site; and
in the middle of the night when he awakens from sleep with coughing, shortness of breath, and a foul,
bitter taste in his mouth. Recently he has developed nausea, without emesis, that is worse in the morning
or after skipping meals. He reports having "heartburn" three or four times a day. When this happens, he
takes a couple of Rolaids or Tums. He keeps a bottle at home, at the office, and in his truck. Vital signs (Vs)
at his physician's office were 130/80 lying, 120/72 standing, 100, 20, 98.6° F (37° C), spo2 92% on room
air. A 12-lead electrocardiogram (ECG) showed normal sinus rhythm with a rare premature ventricular
contraction (PVC).
What are some common causes of chest pain?
Cardiac causes: myocardial infarction (MI), pericarditis, hypertrophic cardiomyopathy, aneurysm
Pulmonary causes: pulmonary emboli, pleurisy, pneumonia, asthma attack, pneumothorax
Gastrointestinal (GI) causes: esophagitis, peptic ulcer disease (PUD), biliary cholic (gallbladder
disease), irritable bowel syndrome (IBS), reflux esophagitis, esophageal spasm
Musculoskeletal causes: costochondritis, muscle strain, osteoarthritis, fibromyalgia
Psychological causes: panic disorder, hyperventilation syndrome
Dermatologic causes: herpes zoster, shingles
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