Mystery Diagnosis: Chest Pain
Calvin is a 48-year-old CEO of a water filtering company who has been experiencing chest pain for 2 weeks. Find out what the most common causes of chest pain are and how his doctor determined the root of his scary symptoms. House Call Doctor is on the case!
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February is American Heart Month. And chest pain is one of the most troubling symptoms that patients experience, and for good reason – heart disease is the number one killer of men and women in the U.S. It also seems to be a very common topic of emails I receive at firstname.lastname@example.org. Unfortunately, it can be one of the most challenging symptoms to dissect, let alone over email, and short answers just won’t do.
So I thought it would be a good idea to instead learn more about chest pain and what really goes through a doctor’s mind when patients first present with this potentially alarming symptom. Let’s learn about chest pain via another mystery diagnosis case.>
The Chief Complaint
Calvin is a 48-year-old man who came to see me in the clinic with a “chief complaint” of chest pain ("chief complaint" is a medical term used to describe the “main symptom”). I had seen Calvin several times in my clinic before for his high blood pressure. He’s an interesting guy – very humorous and loves to talk to me about his 3 rambunctious children (whom I also take care of) and his job as the CEO of his father’s water filtering company. When the economy took a dive, Calvin started to feel the pressure at work. He’s been putting in long hours. And when he goes to bed, his mind really starts to wander and that’s when he feels the stress and subsequent chest pain.
Chest pain has a seemingly endless list of possibilities as a cause, so doctors really need to get more details from the patient – this is referred to as the “history of present illness.”
Calvin reveals that he has been experiencing this chest pain for the last 2 weeks, only at nights when trying to go to sleep. The pain feels like an “ache” right in the middle of his chest, and typically lasts 30 minutes or so. It is moderate in severity, and does not radiate to anywhere else in his body. He humorously adds that his pain seems to magically resolve after taking a few sips of his company's filtered water – Calvin is a great salesman.
The Past Medical History
Calvin is overweight, as he doesn’t make much time for exercise and tends to eat on the go. As a result, he was diagnosed with high blood pressure several years ago, but has been able to control it with a medication that he takes once a day. Other than that, he’s a pretty healthy guy. However, heart disease seems to run in his family and his own father died from a heart attack 10 years ago, leaving him the responsibilities of the business.