Patient With History of Hypertension

My patient who is a 57 year old male who has a past history of Hypertension, takes Accupril to help with his high blood pressure. Is complaining of chest and lest arm pain. He has a blood pressure of 140bpm a high heart rate, and on the ECG showing significant ST elevation and Sinus Tachycardia.

From what my patient is showing and complaining of gives me two differential diagnoses of what he actually might be suffering from.

First diagnoses is Acute Pericarditis which is a disease that must be considered

in the differential diagnosis of my patient as he is complaining of chest pain. This disease results from inflammation of the pericardium which is a tough sac that covers the heart and the base of the vessels (Tingle, Molina & Calvert, 2007).

Second diagnoses is Acute Myocardial Infarct (AMI) is the results from plaque rupture which then followed by the formation of large thrombus that mostly or fully stops the lumen of a coronary artery, which then results in myocardial ischemia, injury and necrosis of myocytes (Wesley, 2011).

Acute pericarditis can vary with the regularity of auscultation also known as the classic Pericardial rub. The pericardial rub is when the patient is auscultated covering the left lower sternal frame and corresponds to the movement of the heart against the pericardial sac. When the patient breathes out and leaning forward It has a creaking sound (Tingle, Molina & Calvert, 2007). We can assume that this 57 year old patient was not showing creaking sounds within his chest. This is present in pericarditis patients, on the other hand with AMI it presents as absent. The symptoms the patient presents are also symptoms of AMI such as he was complaining of numbness in the left arm and chest pain (Zuzelo, 2002). Also the reason why this patient must be suffering from AMI is because he has ST- elevation myocardial infarction (STEMI) which is results from thrombotic blockage of epicardial coronary artery. Infarction of a significant part of the left ventricle can result in evidence of low cardiac output such as, sinus tachycardia which is exactly what the patient was showing on the monitor (Ardehali, Perez & Wang, 2011).

The two assessment tools chosen are the 12 lead ECG and blood tests. The 12 lead ECG provides more detailed views and angles of the hearts electrical activity in both horizontal and frontal planes. The 12 lead has 6 limb leads and the other 6 for chest leads (Phalen & Aehlert, 2006).