Discussion w7 650

Q-1

Mr. Strickland is a 52-year-old male who presents with chest pain 8/10 when exercising and radiates to the shoulders and back, with palpitations, and is relieved by rest. He was prompted for this visit after a recent episode that was unrelieved by rest and three nitroglycerine. He has no known drug allergies, a medical history of hypertension, no surgical history, and social history of being a pack-a-day smoker since he was 15, He drinks approximately three beers a day and more when he goes out with his brother. Mr. Strickland also admits to medication non-compliance and stopping of his hydrochlorothiazide and cholesterol medications after watching television. Mr. Strickland has a positive family history for cardiovascular disease and a brother who had a heart attack when he was 58 years old. Mr. Strickland sees a cardiologist outside of the hospital, but no other healthcare professionals.

After the health interview, I had formulated a list of differential diagnoses that included angina, cardiovascular disease, heart failure, Acute coronary syndrome, Hypertrophic Cardiomyopathy, Muscle Strain, Exercise-Induced Bronchospasm, and Asthma.

EKG shows Regular rate and rhythm at 84 bpm with non-specific S-T changes in V1-4, with no changes when compared to the previous EKG. Cholesterol Lipids levels are high with Cholesterol at 254, VLDL 56, LDL 178, HDL 34. Troponins are elevated at 0.32 ng/mL.

With positive troponins and complaints of chest pain, I would refer cardiology for a cardiac catheterization due to the recent report of the patient’s chest pain being unrelieved by nitro and rest (Hermiz & Sedhai, 2020). However, in this scenario, the cardiac catheterization came back clean and negative.

Upon the result of the negative cardiac cath, the patient is experiencing angina from cardiovascular disease. The patient’s lab results also support this diagnosis (Hermiz & Sedhai, 2020). The patient would need to be started on anti-platelet aggregates, the possibility of blood thinners, and a lot of education on the disease process and the importance of taking the prescribed medications as directed (Ford & Berry, 2020).

However, at the end of the scenario, the program mentioned that further investigation would reveal that the patient had fallen off of a ladder three months ago and had been to the ER multiple times. Further investigation into this new information would reveal that the pain had been consistent with the recent injury and that the patient had been to multiple healthcare professionals over the past three months, all of whom were thinking that it was cardiac-related. At this point, a CT of the thoracic vertebra would be recommended, and the results show a wedge fracture of the body of T5 and a fracture of the spinous process of T5. This would warrant a referral to an orthopedic surgeon (Kumar et al, 2020).

It would seem that all of the healthcare professionals missed the true etiology of this patient’s chest pain, and I have learned from this case by always investigating every route the patient says in order to determine the true etiology of the disease process.

 

References:

Ford, T. J., & Berry, C. (2020). Angina: contemporary diagnosis and management. Heart (British Cardiac Society), 106(5), 387–398. https://doi-org.lopes.idm.oclc.org/10.1136/heartjnl-2018-314661

Hermiz, C. & Sedhai, Y.R. (2020). Angina. StatPearls Treasure Island StatPearls Publishing. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK557672/

Kumar, S., Patralekh, M. K., Boruah, T., Kareem, S. A., Kumar, A., & Kumar, R. (2020). Thoracolumbar fracture dislocation (AO type C injury): A systematic review of surgical reduction techniques. Journal of Clinical Orthopaedics and Trauma, 11(5), 730–741. https://doi-org.lopes.idm.oclc.org/10.1016/j.jcot.2019.09.016

Q-2

Bronchitis is an inflammation of the large airways of the lungs and is usually caused by an infection of the airways usually due to viruses (Singh, Avula, & Zahn, 2019). The common pathogens that can cause bronchitis are influenza A and B, Parainfluenza, and Rhinoviruses (Singh, Avula, & Zahn, 2019). Bronchitis patients usually present with productive cough, malaise, difficulty breathing, and wheezing (Singh, Avula, & Zahn, 2019). Bronchitis usually persists for 10-20 days, but can last up to four weeks (Singh, Avula, & Zahn, 2019).

Pneumonia is an infection of the lung parenchyma and can be caused by a number of different organisms both bacterial and viral (Jain, Vashisht, & Yilmaz, 2020). The origin of pneumonia can be broken down into three etiologies: Community-Acquired Pneumonia, Hospital Acquired Pneumonia, and Ventilator-Associated Pneumonia (Jain, Vashisht, & Yilmaz, 2020). This can be further broken down by classification of infecting organism by atypical or typical (Jain, Vashisht, & Yilmaz, 2020). The location of pneumonia also helps classify it, there is two types: lobar pneumonia which is a diffuse consolidation involving the entire lobe of the lung and is classified by congestion, red hepatization, gray hepatization, and resolution (Jain, Vashisht, & Yilmaz, 2020). Also, the second location is classified as bronchopneumonia and is characterized by inflammation localized in patches around the bronchi (Jain, Vashisht, & Yilmaz, 2020). The presentation of pneumonia is usually with tachypnea, tachycardia, fever with or without chills, decreased or bronchial breath sounds, egophony and tactile fremitus, crackles on auscultation, and dullness on percussion (Jain, Vashisht, & Yilmaz, 2020).

The main characteristic that distinguishes bronchitis from pneumonia is radiological testing of a chest x-ray (Jain, Vashisht, & Yilmaz, 2020). Additional supporting tests include a sputum culture, but that will only help distinguish between viral and bacterial and is not indicated in all presentations (Jain, Vashisht, & Yilmaz, 2020). The sputum culture does not define where the infection is located, just what type of infection it is (Jain, Vashisht, & Yilmaz, 2020).

A common risk factor for both bronchitis and pneumonia is immunocompromising individuals or disease processes that affect the immune system will carry an increased risk for bronchitis and pneumonia (Jain, Vashisht, & Yilmaz, 2020); (Singh, Avula, & Zahn, 2019). Smoking, occupational or hazardous exposures, genetics, and age are also common risk factors for both disease processes (Jain, Vashisht, & Yilmaz, 2020); (Singh, Avula, & Zahn, 2019). Also, colder weather without proper clothing can increase an individual's risk for respiratory infection (Jain, Vashisht, & Yilmaz, 2020); (Singh, Avula, & Zahn, 2019).

Some diseases that would increase an individual's susceptibility for pneumonia but not bronchitis are restrictive lung diseases such as COPD, and Asthma (Jain, Vashisht, & Yilmaz, 2020). Other disease processes include heart failure, kidney disease, and diabetes (Jain, Vashisht, & Yilmaz, 2020).

References:

Jain, V., Vashisht, R., Yilmaz, G. (2020). Pneumonia Pathology. StatPearls Treasure Island StatPearls Publishing. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK526116/

Singh, A., Avula, A.,& Zahn, E. (2019) Acute Bronchitis. StatPearls Treasure Island StatPearls Publishing. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK448067/

Q-3

Bronchitis and pneumonia share many symptoms, but there are also notable differences. In both conditions, inflammation is present, but for bronchitis it is inflammation of the bronchi, and in pneumonia it is inflammation of the lungs. Acute bronchitis is a clinical diagnosis characterized by cough due to acute inflammation of the trachea and large airways without evidence of pneumonia. Both conditions affect the lower part of the respiratory tract, but generally speaking, pneumonia is a more serious condition than bronchitis. Both conditions affect a person’s ability to breathe, but pneumonia has been found to reduce breathing function more than bronchitis (McCabe, 2016).

Bronchitis symptoms include a dry cough, which can progress to mucus. Other symptoms that may accompany bronchitis are typical to those of a cold or flu, like a runny nose, wheezing, headache, and chest pain. The cough associated with acute bronchitis typically lasts about two to three weeks, and this should be emphasized with patients. Acute bronchitis is usually caused by viruses, and antibiotics are not indicated in patients without chronic lung disease. Antibiotics have been shown to provide only minimal benefit, reducing the cough or illness by about half a day, and have adverse effects, including allergic reactions, nausea and vomiting, and Clostridium difficile infection (McCabe, 2016).

Symptoms of pneumonia include coughing with mucus, mild to high fever, shaking chills, shortness of breath that worsens with activity or movement, chest pain, headache, sweating and clammy skin, loss of appetite, low energy, weight loss, fatigue, and confusion. Pneumonia symptoms can also differ depending on the cause of the condition. Bacterial pneumonia symptoms typically include a high fever with perfuse sweating, rapid breathing and heart rate, and confusion and delirium. Viral pneumonia symptoms resemble flu-like symptoms, including fever, headache, muscle pain, and weakness (McCabe, 2016).

Complications that can arise from bronchitis are the progression from acute bronchitis to chronic bronchitis, or the development of chronic obstructive pulmonary disease (COPD). In some cases as well, bronchitis can progress to pneumonia. Complications of pneumonia are lung abscess, fluid accumulation in the lungs, difficulty breathing, and organ failure due to bacteria entering the bloodstream (McCabe, 2016).

 

McCabe P. J. (2011). What patients want and need to know about atrial fibrillation. Journal of Multidisciplinary Healthcare, 4, 413–419. https://doi.org/10.2147/JMDH.S19315