SOAP Presentation – Angina Pectoris

SOAP Presentation – Angina Pectoris

Hi everyone! Welcome to today’s presentation. The focus of this presentation will be on the case of a 67-year-old Hispanic male, SCT, who came to the clinic with chest pain.

Patient Information

In this case presentation, I will share a clinical case of a 67-year-old Hispanic male, Mr. SCT. His chief complaint is: ‘For the past week now, I have had chest pains.’ Mr. SCT was diagnosed with hypertension 10 years ago, which is well controlled with nifedipine, and he reports checking his blood pressure regularly. Moreover, he is a known type 2 diabetes mellitus patient, diagnosed five years ago, on metformin and follows a diabetic diet. Mr. SCT has no known drug and food allergies. He smokes cigarettes occasionally. There is a family history of cardiovascular disease in the family. His father died at the age of 60 years due to myocardial infarction. Such a family history puts Mr. SCT at a higher risk of cardiac diseases; hence, his current symptoms are alarming. There is no history of any surgeries or prior hospital admission.

Physical Exam Findings

On examination, Mr. SCT is well-kempt, well-nourished, and not in any respiratory distress. His vital signs are as follows: the blood pressure is 150/90 mmHg, pulse rate is 85 beats per minute, respiratory rate is 16 per minute, and temperature is 98. 6°F. The cardiovascular system assessment shows no abnormalities. S1 and S2 heart sounds were heard; there were no murmurs, rubs, or gallops. There is no wheezing, crackles, or rhonchi; his lungs are clear to auscultation bilaterally. There were no visible distended neck veins. His jugular venous pressure (JVP) was normal; his peripheral pulses were present, of good volume and character, and bilaterally asymmetrical in both the upper and lower limbs, which suggested adequate peripheral perfusion. There is no jaundice, cyanosis, or peripheral edema.

Differential Diagnosis

Angina Pectoris (ICD-10 Code: I20.9): Angina pectoris is a clinical condition characterized by chest pain secondary to myocardial ischemia. It manifests itself as a feeling of pressure in the chest area, more often originating in the neck and extending to the left shoulder blade and is often occasioned by vigorous activities or stress. This condition is the main concern for the case of Mr SCT since he has a history of high blood pressure and diabetes, both of which are precursors to heart disease. The characteristic of pain, which is chest pain on exertion and resolved by rest, strongly points towards chest pain associated with physical activity, thus qualifying as angina pectoris and should be considered in patients. (Joshi & De Lemos, 2021).

Gastroesophageal Reflux Disease (GERD) (ICD-10 Code: K21.9): GERD is a condition that is characterized by the backflow of stomach acid into the esophagus, hence causing irritation. Signs include heartburn and chest pains that are similar to angina (Tamargo & Lopez-Sendon, 2022). GERD is a possible differential for Mr. SCT due to the chest pain, particularly burning chest pain as it might be a result of reflux. The absence of symptoms like shortness of breath and the episodic nature of the pain, which could correlate with meals or lying down, make GERD a plausible differential diagnosis. However, the exertional component of his pain makes GERD less likely than angina.

Musculoskeletal Pain (ICD-10 Code: M79.1): Musculoskeletal pain, which can result from strain, injury, or inflammation of the chest wall muscles, is another differential diagnosis. It often presents as localized pain that may worsen with specific movements or palpation (Tamargo & Lopez-Sendon, 2022). This is considered for Mr SCT because musculoskeletal issues can mimic cardiac pain, especially if there is any recent history of physical strain or trauma, which he has not reported. Despite this, musculoskeletal pain is included due to the need to rule out all possible sources of chest discomfort, particularly those exacerbated by movement.

Costochondritis (ICD-10 Code: M94.0): Costochondritis is an inflammation of the cartilage connecting the ribs to the breastbone, leading to localized chest pain that can be sharp or aching. It is considered in Mr. SCT’s differential diagnosis because it can cause chest pain similar to that of cardiac origin. The pain from costochondritis often worsens with deep breaths or physical activity involving the chest (Tamargo & Lopez-Sendon, 2022). Given Mr. SCT’s description of exertional chest pain, costochondritis is a less likely but possible cause, especially if palpation of the chest wall reproduces the pain, which should be evaluated during the physical examination.

Final Diagnosis & Treatment Plan

Diagnosis: Stable Angina Pectoris

The final diagnosis for Mr. SCT is stable angina pectoris. This decision is based on his presentation of pressure-like chest pain radiating to his left shoulder, triggered by physical exertion and relieved by rest. His history of hypertension and diabetes, both significant risk factors for coronary artery disease, supports this diagnosis. Additionally, the pain’s pattern and characteristics align with classic angina symptoms. The absence of acute symptoms such as diaphoresis or severe shortness of breath further suggests stable rather than unstable angina (Joshi & De Lemos, 2021).

Lifestyle Changes:

Smoking Cessation: Since Mr. SCT smokes, quitting smoking is critical as smoking is a major risk factor for coronary artery disease. Smoking contributes to the development of atherosclerosis and can exacerbate ischemic episodes (Tamargo & Lopez-Sendon, 2022).

Diet: Adopting a heart-healthy diet low in saturated fats, cholesterol, and sodium can help manage both his hypertension and diabetes, reducing the overall risk of cardiovascular events (Tamargo & Lopez-Sendon, 2022).

Exercise: Regular, moderate exercise can improve cardiovascular health by enhancing blood flow, reducing blood pressure, and improving glucose control, which is particularly beneficial for Mr SCT’s diabetes management (Tamargo & Lopez-Sendon, 2022).

Medications:

Nitroglycerin: Nitroglycerin is prescribed for acute pain episodes. It works by dilating blood vessels, which reduces the heart’s workload and improves blood flow to the myocardium, thereby relieving angina symptoms (Joshi & De Lemos, 2021).

Aspirin: Aspirin is recommended for its antiplatelet effects, which help prevent the formation of blood clots that can obstruct coronary arteries, reducing the risk of myocardial infarction (Joshi & De Lemos, 2021).

Beta-blocker: A beta-blocker is included in the treatment plan to manage hypertension and reduce cardiac workload. Beta-blockers reduce myocardial oxygen demand by slowing the heart rate and decreasing the force of contraction, which is crucial in preventing angina episodes (Joshi & De Lemos, 2021).

Continue with Nifedipine for his Hypertension: Nifedipine is a calcium channel blocker. It works for Mr. SCT’s hypertension by helping in the relaxation of the blood vessels and improvement of blood flow. This decreases the workload of the heart and prevents angina, among other cardiac effects. (Joshi & De Lemos, 2021).

Continue with Metformin for his Diabetes: Metformin controls Mr. SCT’s type 2 diabetes. This is important as diabetes is a risk factor for coronary artery disease; hence, Mr. SCT requires good glucose regulation. Achieving and keeping normal blood glucose levels is useful in the prevention of any additional cardiovascular issues (Joshi & De Lemos, 2021).

Follow-Up

The next appointment for Mr. SCT is scheduled after one month to evaluate the therapy plan and response to medications and to modify them if needed. This follow-up is necessary for the regulation of his symptoms and to prevent the possibility of the development of other severe cardiac problems.

References

Joshi, P. H., & De Lemos, J. A. (2021). Diagnosis and management of stable angina: a review. Jama, 325(17), 1765-1778. 10.1001/jama.2021.1527

Tamargo, J., & Lopez-Sendon, J. (2022). Ranolazine: a better understanding of its pathophysiology and patient profile to guide treatment of chronic stable angina. Future Cardiology, 18(3), 235-251. https://doi.org/10.2217/fca-2021-0058

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We’ll write everything from scratch

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PLEASE CREATE AN ORAL PRESENTATION SCRIPT ON WHAT I WILL SAY IN THE PRESENTATION.

TOPIC: ANGINA PECTORIS
INITIAL: SCT
GENDER: MALE
AGE: 67
NATIONALITY: HISPANIC

In part, I, record yourself presenting a 4-8 minute oral case presentation for a patient seen in the clinic this week or last. Focus on a chronic condition or an interesting case, but exclude medication or lab follow-ups. Dress professionally and ensure a distraction-free environment. The presentation should begin with ID, CC, and HPI, and cover medical history, exam findings, a DDX list, final diagnosis, and treatment plan according to the SOAP rubric.
Please make sure to create a citation on the script and an APA reference from the last 5 years

Expectations
Initial Post:
• Due: Thursday, 11:59 pm PT
• Length: 4-8 minutes as a YouTube video.
• Citations: At least TWO high-level scholarly references in APA from within the last 5 years
PART 2:

I WILL CREATE A SEPARATE ORDER OF SOAP NOTES THAT IS RELATED TO THIS PRESENTATION

Your SOAP note, which is due later in the week, should be based on the same patient you discussed in your presentation. Incorporate the feedback you receive from your peers or instructor. This means you might adjust the care plan in the written note to align with evidence-based medicine and enhance your learning process, even if it is not the same as it was in the clinic.

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