Exploring the causes of persistent chest pain in a 34-year-old man with COVID-19 history: A differential diagnosis analysis

ASSIGNMENT INSTRUCTIONS:

Based on the following information, create a list of three differential diagnoses and explain why you would include them on your list. Use the format displayed in the “Discussion Forum Sample.”
History
C.R., a 34-year-old man, came to your clinic with an episode of chest pain. He has a previous history of occasional stabbing chest pain for 2 years. The current pain had come on 4 hours earlier at 8 p.m. and has been persistent since then. It is central in position, with some radiation to both sides of the chest. It is not associated with shortness of breath or palpitations. The pain is relieved by sitting up and leaning forward. Two Tylenol tablets taken earlier at 9 p.m. did not make any difference to the pain.
The previous chest pain had been occasional, lasting a second or two at a time and with no particular precipitating factors. It has usually been on the left side of the chest although the position has varied.
Two weeks previously he had mild to moderate symptoms of COVID-19 which lasted 14 days. This consisted of a sore throat, low-grade fever, loss of taste and smell, and a cough. His wife and two children were ill at the same time with similar symptoms but have been well since then. He has a history of migraines. In the family history, his father had a myocardial infarction at the age of 51 years and was found to have a marginally high cholesterol level. His mother and two sisters, aged 36 and 38 years, are well. After his father’s infarct, he had his lipids measured; the cholesterol was 5.1 mmol/L (desirable range < 5.5 mmol/L). He is a nonsmoker who drinks two 12-packs of beer per week.
Examination
His pulse rate is 75/min, blood pressure is 124/78 mmHg. His temperature is 37.8C. There is nothing abnormal to find in the cardiovascular and respiratory systems. The ECG findings include diffuse concave-upward ST-segment elevation and, occasionally, PR-segment depression.

HOW TO WORK ON THIS ASSIGNMENT (EXAMPLE ESSAY / DRAFT)

A typical symptom that might indicate several medical issues are chest pain. C.R., a 34-year-old man with a history of sporadic chest discomfort, arrived at the clinic complaining of ongoing chest pain that had persisted for the previous four hours. The chest pain is located in the center and radiates to both sides. Additionally, he reported feeling relieved after standing up and bending forward, with no accompanying breathlessness or palpitations. Three alternative explanations for his ongoing chest pain are as follows:

Acute Pericarditis: This disease is characterized by inflammation of the pericardium, the sac-like membrane that encircles the heart. Sharp, pleuritic chest pain that is generally eased by sitting up and leaning forward is how it manifests. Usually central or left-sided, the pain may radiate to the shoulders, neck, or back. Pericarditis may occasionally result from COVID-19 infection, which makes it a likely possibility in C.R.’s case.

Myocardial Infarction: Also referred to as a heart attack, myocardial infarction (MI) happens when the blood supply to a portion of the heart muscle is cut off, causing damage to the heart muscle. The main sign of MI is chest discomfort, which is frequently described as a pressure, tightness, or squeezing feeling. When MI occurs, the pain may occasionally radiate to the arms, back, or jaw. The possibility of MI is raised by C.R.’s family history.

Gastroesophageal Reflux Disease (GERD): GERD is a condition in which the esophagus becomes irritated and inflamed due to the reflux of stomach acid. Chest pain, which is frequently characterized as having a burning sensation, can be a symptom of GERD. Regurgitation, belching, and a sour taste in the mouth may also be present. GERD is a tenable diagnosis given C.R.’s history of sporadic chest pain without any clear triggering causes.

In conclusion, there may be several underlying causes for C.R.’s ongoing chest pain. Acute pericarditis, myocardial infarction, and gastroesophageal reflux disease, however, are possible differential diagnoses based on the patient’s medical history and physical examination. To confirm the diagnosis and choose the patient’s best course of therapy, more diagnostic tests are required.