Differential Diagnosis I: Myocardial Infarction
Rationale for diagnosis: Signs and symptoms of myocardial infarction include chest pain or discomfort, shortness of breath, sweating or cold, clammy skin, and a racing or uneven heartbeat (Crowley & Martin, 2019). Risk factors of a MI include, but not limited to, family history of MI, being male 45 years of age or older, history of smoking, high blood pressure and obesity (Mayo Clinic, 2018). The patient’s chief complaints included dyspnea and chest pain. Given the patient’s history and risk factors present, a diagnosis of myocardial infarction is plausible. However, the patient stated that he noticed mild chest discomfort a week ago, but denied any chest pain during admission. The timing of the symptoms does not align with a differential diagnosis of myocardial infarction, and could instead correspond with stable angina related to his CAD.
Most common heart attack signs in men and women; (Courtesy of Heart Sisters organization, Caley Thomas).
Differential Diagnosis II: COPD Exacerbation
Rationale for diagnosis: COPD risk factors include a history of smoking, exposure to indoor and outdoor pollution, and occupational hazards (Mannino & Buist, 2007). The patient’s social history includes smoking (current, every day smoker for 25 years) and exposure to environmental/chemical pollutants. The patient complains of shortness of breath, and presents with central cyanosis (blue coloring of the lips). These subjective and objective findings, in combination with the patient’s increased risk of developing COPD because of the risk factors present, provides rationale for considering COPD exacerbation as a differential diagnosis. On the other hand, the patient has a history of asthma. Symptoms of an asthma attack can be similar to that of COPD exacerbation, and behaviors such as smoking can trigger an attack. While many of the symptoms align with COPD, one of the classic signs of COPD is the presence of a cough, and usually one that is productive. The lack of cough indicates exploring other diagnoses.
Wedzicha, J. & Seemungal, A. (2007). COPD exacerbations: defining their cause and prevention. Lancet 2007; 370:786-796.
Wedzicha, J., Brill, S., Allinson, J., et. al. (2013). Mechanisms and impact of the frequent exacerbator phenotype in chronic obstructive pulmonary disease. BMC Med 2013; 11: 181.
Differential Diagnosis III: Anxiety Disorder
Rationale for diagnosis: Common anxiety disorder signs and symptoms include tachypnea, tachycardia and abnormal excess sweating (Mayo Clinic, 2018). The patient’s self-report of having increased anxiousness, along with the assessment findings of increased heart rate, respiratory rate and sweating support anxiety disorder as a differential diagnosis. Conversely, the patients symptoms seem to be related to his exertion rather than any emotional triggers. Upon admission, the patient did not report any psychosocial stressors that would would account for his symptoms. In addition to this, the patient’s report of central cyanosis suggests underlying hypoxemia, in which anxiety disorders are unlikely to be the cause of.
