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dr abid
dr abid, Board Certified Physician
Category: Cardiology
Satisfied Customers: 5985
Experience:  Iam a medical specilaist and now doing training in Cardiology and have more then ten years experience in respective field.
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Sean is a 52 year-old male with a history of hypertension.

Customer Question

Sean is a 52 year-old white male with a history of hypertension. He was taken off HTN meds at last visit almost 3 months ago. You note he is not due for a follow up at this time, so you look at the chief complaint.CC: chest pain 3 days agoYou enter the room and introduce yourself. Sean is sitting in the chair texting on his cell phone. You ask what brings him in today. Sean smiles, shaking his head and says “My wife made me come, I feel fine.” Three days ago Sean felt short of breath, had this heavy feeling in his chest, and he got kind of nauseous and sweaty. It lasted only about 3 minutes, and it has not happened again, but he does feel a little more tired. “It could be that I have not worked out since it happened, and I have more energy when I walk on the treadmill.”PMHx: Reports general health as good. Had been feeling great since starting to work out and lost weight. Had lots of energy and felt great until this episode 3 days ago. Now he is a little concerned because he feels a little more tired when he works out. He has not done as much strenuous running and shortened his workout since the episode.Childhood/previous illnesses: chicken pox.Chronic illnesses: Hypertension, Lisinopril stopped 3 months ago. Elevated cholesterol, lifestyle management was initiated.Surgeries: T and A, cholecystectomy, vasectomyHospitalizations: NoneImmunizations: Does not receive the flu shot.Allergies: NKDABlood transfusions: NoneEnjoys a beer or a glass of Jameson and the occasional cigar when playing poker with his buddiesCurrent medications: NoneSocial Hx: Married for 20 years, works as a mortgage broker at a local bankFamily Hx: Parents are deceased. Father had lung CA and mother died from complications of a stroke. Brother died at 44 from malignant melanoma. Other sister and brother are healthy.I am trying to pinpoint 3 differential diagnosis for this patient...? As well as any further questions I need to make sure to ask this patient and what body systems I would examine along with pertinent positive/negatives in each system and any diagnostic tests I need to perform
Submitted: 1 year ago.
Category: Cardiology
Expert:  dr abid replied 1 year ago.

Hi. I am Dr Abid.Welcome to Just Answer and thank you for the question.
I'm reviewing your question now and will post back with your reply.

Expert:  dr abid replied 1 year ago.

This is highly likely the Angina , known case of Hypertension with chest pain , shortness of breath , feeling of tiredness , highly likely the heart pain , this shouldnot be taken as ordinary and immediately he should proceed with EKG , Coronary angiography /.

Other least likely possibilities are chest infection and GERD .

You can ask about fever , cough , stomach issues , association of chest pain with breathing , aggravating and reliving factors .

Regards .

“Please let me know if you have any further questions. And please take the time to leave me a positive rating if you are satisfied with the answer. You can always ask me for a follow-up question post rating the answer. You can also ask for me in the future by going on the link”

Customer: replied 1 year ago.
what kind of chest infection would you put for a differential? and do you think this patient need the ER or is it okay to refer him to cardiology for a workup ASAP
Expert:  dr abid replied 1 year ago.

Least likely Viral infection , respiratory viral infection that leads to Pleuritic type chest pain along with Lethargy .

Regards .

Customer: replied 1 year ago.
if we had to narrow it down to three differentials what specifically do u think are most appropriate....
Expert:  dr abid replied 1 year ago.

The most likely is the ANGINA .

This should be investigated as early as possible and at least before going to Cardiologist , EKG Should be done from ER .

Regards .

Please leave positive feedback for me .

Thanks .

Customer: replied 1 year ago.
what about two other differentials, other options to look at?
Expert:  dr abid replied 1 year ago.

Other are least likely options , which are not life threatening and need no immediate attention , Heart issue should be ruled out first , as early as possible please .

Regards .

Customer: replied 1 year ago.
Which other options are we looking at?
Expert:  dr abid replied 1 year ago.

No more options other than Angina .

Regards .