When a patient presents to a primary care provider with a complaint of chest pain, there are a number of possibilities that must be considered. Discuss the first three steps you would complete in assessing a patient with this complaint. Then, discuss at least two differential diagnoses for a patient with chest pain. How would the treatment and intervention course differ for each diagnosis?

Expert Answer and Explanation

Chest Pain

Patient Assessment

Various reasons can lead to patients exhibiting chest pain ranging from life-threatening to non-life-threatening scenarios. As a primary care provider, one needs to be aware of how to mitigate complications associated with chest pains including the initial assessment to analyze the cause and type of pain (Chew et al., 2016). The analysis is aimed at identifying the potential cause of the pain and if possible, help the patient recover from the pain, while chest pains are not usually a result of cardiac arrest, primary care providers need to assume that there is a possibility of cardiac arrest unless proven otherwise.

The first step to perform an accurate chest pain assessment is to conduct the PQRST pain assessment technique. The technique begins by identifying the position (P) and provoking factors followed by analyzing the quality (Q) in terms of pressure, burning, sharpness, or cramping (Chew et al., 2016). The next would be to ascertain whether the pain radiates (R) to different areas, the severity (S), and the time (T) the pain is estimated to have started. The second step that the primary care provider can take would be to rest and reassure the patient as the necessary medical intervention is considered. The third key step would be to relieve the pain using mild analgesics and pain relievers (Chew et al., 2016). These steps are more important for the primary care provider as they help intervene in the situation and prevent potential implications. In the event of a cardiac arrest, the speedy intervention can save the life of the patient and increase the chances of survival. If the pain is cardiac, the most preferred course of action for a primary care provider is to ensure there is a sufficient supply of oxygen to the heart (Chew et al., 2016). A care provider can conduct goal-directed oxygen therapy, provision vasodilators or antiplatelet aggregators such as aspirin.

Differential Assessment

There are cases when chest pains are not cardiac related and the diagnosis can be different suited to the potential different issue. The two examples of a differentiated diagnosis for chest pains can be that of chest wall pain and Gerd (McConaghy et al., 2020). A patient with chest wall pain can present with symptoms such as muscle tension, palpitating pain, and there would be an absence of cough. Gerd on the other hand is a result of acid regurgitation leading to burning retrosternal pain. Treatment for chest wall pains varies but patients can be given muscle relaxers, physical therapy, stretching, and medication such as ibuprofen (Bader et al., 2020). Gerd on the other hand can be treated using proton pump inhibitors which reduce the production of excess acid in the stomach.

References

Bader, A. S., Rubinowitz, A. N., Gange Jr, C. P., Bader, E. M., & Cortopassi, I. O. (2020). Imaging in the evaluation of chest pain in the primary care setting, part 2: sources of noncardiac chest pain. The American Journal of Medicine, 133(10), 1135-1142.

Chew, D. P., Scott, I. A., Cullen, L., French, J. K., Briffa, T. G., Tideman, P. A., … & Aylward, P. E. (2016). National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016. Medical Journal of Australia, 205(3), 128-133. https://doi.org/10.5694/mja16.00368

McConaghy, J. R., Sharma, M., & Patel, H. (2020). Acute Chest Pain in Adults: Outpatient Evaluation. American Family Physician, 102(12), 721-727.

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