N512 Advanced Pathophysiology Acute Pericarditis
Jackie Johnson is described as a married 35-year-old African American female who has presented to the emergency room with: Chest pain, which she rates 8 out of 10 on a scale ranging from 1 to 10. The pain is verbalized to be sharp in nature, worsens with deep breaths, is retrosternal, and is improved when “leaning forward”. In addition, she also indicates having had “flu like illness” within the past few days such as fever, rhinorrhea, and cough. She denies any additional medical history and is not taking any medication. Also, she denies any alcohol, tobacco, or drug use. Of note, she is reported to work as an Advertising Executive. N512 Advanced Pathophysiology Acute Pericarditis.
Upon physical examination findings she appears in moderate distress from pain, with a blood pressure of 125/85 mm Hg, heart rate 105 bpm, respiratory rate 18/min, and oxygen saturation of 98% on room air. She is currently afebrile. Her head and neck examination are notable for clear mucus in the nasal passages and a mildly erythematous oropharynx N512 Advanced Pathophysiology Acute Pericarditis. The neck is supple, with shotty anterior cervical lymphadenopathy. The chest is clear to auscultation. Jugular veins are not distended. Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal.
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Given the patients report and the physical examination obtained, factors aside from medical findings to keep in mind when moving forward are: A highly stressful job, her sex, her race, and her marital status, which may contribute to stress levels as well.
After assessment of the findings presented, J.J’s likely Diagnosis is Acute Pericarditis, which is an inflammation of the pericardium, caused by the sac’s layers becoming inflamed and possibly rubbing against the heart (American Heart Association, 2016). A client with acute pericarditis will complain of chest pain that worsens with deep breaths or while coughing when lying down and is relieved by positional changes, such as leaning forward or sitting up (Hammer & McPhee, 2019) N512 Advanced Pathophysiology Acute Pericarditis. Also, a clinical finding in patients with acute pericarditis is a high-pitched squeaking sound upon cardiac auscultation, which may be indicative of pericardial rub (Hammer & McPhee, 2019). The presence of pericardial rub often indicates complications of pericarditis such as an increase in fluid between the layers of the pericardium which causes the rubbing between the pericardium and heart, pericardial effusion (Hammer & McPhee, 2019), this best explains the pathophysiological mechanism causing the chest pain for J.J currently. N512 Advanced Pathophysiology Acute Pericarditis J.J’s cardiac exam shows tachycardia, as evidenced by a heart rate of 105, with a three-component high pitched squeaking sound, which is a finding indicative of acute pericarditis, but may also be indicative of complications related to pericarditis (American Heart Association, 2016).
Causes of pericarditis include viral, bacterial, protozoal, and mycotic infections (Hammer & McPhee, 2019) or its cause can be idiopathic. Per J.J’s report of “flu like illness for the past few days” which include fever, rhinorrhea, and cough lead me to believe that a likely cause of the pericarditis is a virus. The mild erythematous oropharynx, and shotty anterior cervical lymphadenopathy noted during the physical exam are also indicative of viral cause.
Though acute pericarditis is the likely diagnosis for J.J given her relatively healthy history, further assessment and diagnostic testing should be obtained to confirm and or rule out other cardiac related illnesses that may present with similar symptoms. In the case of J.J, the symptoms presented do not coincide with clinical manifestations exhibited in other cardiac related illnesses N512 Advanced Pathophysiology Acute Pericarditis. Her blood pressure is within normal limits, her respirations are normal, O2 Sat is WNL, jugular veins are not distended, and is not experiencing dyspnea. The clinical findings exhibited: elevated heart rate, mild erythematous oropharynx, shotty anterior cervical lymphadenopathy, tachycardia with 3-component high pitched squeaking sound are all symptoms that point to pericarditis. However, we must also take into consideration that there are non-cardiac related conditions that can also present in the form of chest pain (Fass, R., & Achem, S.R, 2011). Psychological disorders such as panic, anxiety, and depression can also clinically manifest with chest pain (Huffman, J., Pollack, M., & Stern, T., 2002). Given J.J’s high demanding job, we can suspect that she experiences high levels of stress that can contribute to anxiety, but in order to further diagnose this, more information needs to be obtained N512 Advanced Pathophysiology Acute Pericarditis.
Considering that, “Heart disease and stroke are the No. 1 killers in women, and affects African American women disproportionately, making diabetes, smoking, high blood pressure, high cholesterol, physical inactivity, obesity and a family history of heart disease all greatly prevalent among African-Americans and are major risk factors for heart disease” N512 Advanced Pathophysiology Acute Pericarditis (American Heart Association, 2016), I would want to investigate further into family history, and monitoring of cholesterol as well as potential for hypertension.
In order to increase J.J’s prognosis, a thorough assessment should be completed including an ECG, Chest X-ray, echocardiogram, and obtaining labs for signs of inflammation (American Heart Association, 2016). In addition, perhaps also including cholesterol screening would be helpful collateral information to better treat J.J. Currently, her blood pressure appears to be within normal limits, but I would want to monitor this as well. N512 Advanced Pathophysiology Acute Pericarditis Lastly, I’d also want to examine J.J’s psychological and mental status to rule out anxiety related disorders, which could have also contributed to her chest pain.
Acute Pericarditis has been known to clear up on its own with simple treatment (American Heart Association, 2016). Treatment, however, will be dependent on the cause (American Heart Association, 2016). Upon discharge, the recommendation for J.J will likely be anti-inflammatory medication in higher doses than usual, such as Motrin, or Aleve in order to alleviate the pain, and rest (American Heart Association, 2016), since she has no other known medical history and is relatively young. She should follow up with a cardiologist to monitor for recurrence. N512 Advanced Pathophysiology Acute Pericarditis
References:
American Heart Association (2016, March 31). Retrieved from
https://www.heart.org/en/health-topics/pericarditis/what-is-pericarditis
Fass, R., Achem, S.R. (2011). Noncardiac Chest Pain: Epidemiology, Natural Course and Pathogenesis. Journal of Neurogastroenterology and Motility,17:110-123.https://doi.org/10.5056/jnm.2011.17.2.110
Hammer, G., & McPhee, S. (2019). Pathophysiology of disease: An introduction to clinical medicine (8t ed.). New York, NY: McGraw-Hill Medical.
Huffman, J., Pollack, M., & Stern, T. (2002). Panic Disorder and Chest Pain: Mechanisms,
Morbidity, and Management. Primary Care Companion to The Journal of Clinical
Psychiatry, 4(2):54-62.doi: 10.4088/pcc.v04n0203 N512 Advanced Pathophysiology Acute Pericarditis
Discussion 2
Jackie Johnson, a 35 y.o. African-American, married female, advertising executive, presents to the emergency department with complaints of chest pain. The pain is described as 8 on a scale ranging from 1 to 10, retrosternal, and sharp in nature N512 Advanced Pathophysiology Acute Pericarditis. It radiates to the back, is worse with taking a deep breath, and is improved by leaning forward. On review of systems, she has noted a “flulike illness” over the last several days, including fever, rhinorrhea, and cough. She has no medical history and is taking no medications. She denies tobacco, alcohol, or drug use. On physical examination, she appears in moderate distress from pain, with a blood pressure of 125/85 mm Hg, heart rate 105 bpm, respiratory rate 18/min, and oxygen saturation of 98% on room air. She is currently afebrile. Her head and neck examination is notable for clear mucus in the nasal passages and a mildly erythematous oropharynx. The neck is supple, with shotty anterior cervical lymphadenopathy. The chest is clear to auscultation. Jugular veins are not distended. Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal. N512 Advanced Pathophysiology Acute Pericarditis
In this discussion:
- Provide and discuss this patient’s likely diagnosis with your colleagues. Why do you support this “likely” diagnosis?
- Discuss your differential diagnoses clinical reasoning. Why do you support this list of potential differential diagnoses?
- Provide and discuss what the most common causes of this disease are, and which is most likely in this patient?
- Identify the pathophysiologic mechanism for her chest pain.
- Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports.
- N512 Advanced Pathophysiology Acute Pericarditis
Support your discussion with citations from the external literature and your textbook.
Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria. N512 Advanced Pathophysiology Acute Pericarditis