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A 65 year old man comes to the doctor's office complaining of a sharp pain in the right...

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ladyc60 | Salutatorian

Posted October 6, 2013 at 2:00 AM via web

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A 65 year old man comes to the doctor's office complaining of a sharp pain in the right side of his chest. He says his chest hurts when he breathes deeply or coughs. He also been coughing a lot, has difficulty drawing breath and feels a tightness in his chest. What condition might the doctor suspect or methods of diagnosis would the doctor use to pinpoint the cause of the patient's complaints?

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kipling2448 | (Level 1) Educator Emeritus

Posted October 7, 2013 at 1:23 AM (Answer #1)

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A 65-year old patient complaining of chest pain, specifically in the right side, difficulty breathing and a persistent cough will likely be sent to an emergency room for prompt diagnostic tests.  Chest pains normally associated with the heart are usually on the left side of the chest, as well as, but not necessarily, present in the left shoulder and arm.  Any physician would automatically listen to the heart and lungs using a stethoscope, and might order chest x-rays if the capability exists within the office.  Right side chest pains, however, are unlikely to be symptomatic of a heart attack, but could indicate a very serious problem affecting the cardiovascular system such as angina, in which blood flow to the heart is obstructed or weakened, or inflammation of the liver or gallbladder.  In addition, any number of other medical problems can radiate pain in the right side of chest, and absent the other symptoms, the possibility would be considered that the cause is simple indigestion.

When all the symptoms are taken into account, however, a series of tests and diagnostic procedures would likely be ordered.  While a heart attack would be unlikely, circulatory problems could be involved and could be life-threatening.  A quick and easy test that would almost certainly be used, and could be performed in the primary care physician’s office, would be an electrocardiogram, or EKG, which could identify heart issues including pericarditis, an inflammation of the sac surrounding the heart, the aforementioned possibility of angina, or other forms of heart disease.  As it could logically be assumed that the attending physician has taken the patient’s medical history into account – which would include habits like smoking and conditions often associated with life-style choices and/or genetics like high cholesterol and diabetes. 

Depending upon the results of the EKG, an ultrasound of internal organs like the liver and gallbladder might be recommended, the former organ being considerably more worrisome than the latter, given the seriousness of liver damage.  A persistent cough be associated with either the cardiovascular or respiratory systems, but the other symptoms described – sharp chest pain and difficulty breathing – would likely lead the physician to suspect a potential heart problem, either involving the heart itself, or the avenues through which blood and oxygen flow to and from the heart, a problem that could require immediate bypass surgery. 

Once again, some of the process by which a physician would treat a 65-year old patient with symptoms described in the question would involve reference to the individual’s prior medical history.  That said, immediate use of a stethoscope and administration of an EKG would provide the quickest sense of the nature of the underlying problem.

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