Differential Diagnosis I
Mitral Valve Prolapse
Rationale: Patient has a family history of connective tissue disorders such as Ehlers-Danlos syndrome and osteogenesis imperfecta. He presents with tachycardia, chest tightness, and fatigue. An echocardiography would be useful in this situation to diagnose, providing there were no findings upon auscultation (McCance & Huether, 2019).
Figure 1. How Mitral Valve Prolapse affects the heart (Courtesy of Divers Alert Network)
Differential Diagnosis II
Myocardial Infarction
Rationale: The patient’s presentation to the emergency department with complaints of chest pain and a “tight feeling” spreading through his chest may indicate a myocardial infarction. The patient has a history of coronary artery disease, which contributes to this differential diagnosis. “Acute coronary syndrome” is often the cause of “unstable angina, myocardial infarction…, or sudden death,” as the plaque build up from coronary disease “is associated with >75% luminal narrowing and probably a luminal thrombus…” (Yahagi, et.al., 2015). The symptoms the patient presents with could be an exacerbation of coronary disease, and the plaque in the patient’s arteries may cause a thrombus which travels to the heart and causes an acute myocardial infarction.
Figure 2. Pathophysiology of Myocardial Infarction (Courtesy of Medical Institution)
Differential Diagnosis III
Acute Asthma Exacerbation
Rationale: Patient’s presents to the ER with shortness of breath with difficulty breathing and a “tight feeling” in his chest. Patient has a history of asthma, which he describes as “moderately-well controlled” presenting a rationale for an acute asthma exacerbation as a differential diagnosis. Airway obstruction increases resistance to airflow and decreases flow rates, especially expiratory flow. Impaired expiration causes air trapping, hyperinflation distal to obstructions, and increased work of breathing (McCance & Huether, 2013).
Figure 3. How Bronchospasm Constricts the Airway (Shari J. Lynn, MSN, RN, and Kathryn Kushto-Reese, MS, RN)