of chest discomfort for about 90 minutes. He has had occasional symptoms for amonth, but it is worse today. Today’s symptoms began while he was walking hisdog and decreased slightly with rest, but have not resolved. He describes the feeling as a pressure sensation in the left substernal area of his chest associated with shortness of breath and mild diaphoresis. He does not have any radiation of the discomfort today but has experienced radiation to the left upper extremity in the past. The patient denies any health problems, but his wife reports that he has not seen a physician in years. His wife made him come in because his younger brother had a heart attack 6 months ago. He is a vice president of a bank and lives with his wife and three daughters. He has smoked 1½ packs of cigarettes per day for more than 30 years and denies drinking alcohol or any drug use.On physical examination, he is an anxious, obese gentleman who appears paleand has a moist brow. His temperature is 98.8°F (37.1°C), his pulse is 105 beats/min,his respirations are 18 breaths/min, his blood pressure is 190/95 mm Hg, his heightis 74 in, and his weight is 250 lb. Cardiac examination reveals regular rhythm without murmur, but he has an S4 gallop. Lungs are clear to auscultation. Neck is without carotid bruits or jugular venous distension. Abdomen is normal. He does have a right femoral bruit. Extremities reveal trace edema but no cubbing or cyanosis. He has 2+ pulses in radial and dorsal pedals arteries. Rectal examination has no masses or tenderness with a normal prostate, and is guaiac negative.

Question Answered step-by-step A 56-year-old man is brought to the emergency department (ED) complaining What is your most likely diagnosis?of chest discomfort for about 90 minutes. He has had occasional symptoms for amonth, but it is worse today. Today’s symptoms began while he was walking hisdog and decreased slightly with rest, but have not resolved. He describes the feeling as a pressure sensation in the left substernal area of his chest associated with shortness of breath and mild diaphoresis. He does not have any radiation of the discomfort today but has experienced radiation to the left upper extremity in the past. The patient denies any health problems, but his wife reports that he has not seen a physician in years. His wife made him come in because his younger brother had a heart attack 6 months ago. He is a vice president of a bank and lives with his wife and three daughters. He has smoked 1½ packs of cigarettes per day for more than 30 years and denies drinking alcohol or any drug use.On physical examination, he is an anxious, obese gentleman who appears paleand has a moist brow. His temperature is 98.8°F (37.1°C), his pulse is 105 beats/min,his respirations are 18 breaths/min, his blood pressure is 190/95 mm Hg, his heightis 74 in, and his weight is 250 lb. Cardiac examination reveals regular rhythm without murmur, but he has an S4 gallop. Lungs are clear to auscultation. Neck is without carotid bruits or jugular venous distension. Abdomen is normal. He does have a right femoral bruit. Extremities reveal trace edema but no cubbing or cyanosis. He has 2+ pulses in radial and dorsal pedals arteries. Rectal examination has no masses or tenderness with a normal prostate, and is guaiac negative. What is your next diagnostic step?What is the next step in therapy?  Health Science Science Nursing BIOL MISC Share QuestionEmailCopy link Comments (0)