A Comprehensive Medical Diagnosis for a Patient with Racing Heart, Fatigue, Weakness, and Dyspnea: Assessing Cardiac and Non-Cardiac Factors

QUESTION

what medical diagnosis for patient with episode of racing heart (rate 120) in 24 hours, progressive fatigue and generalized weakness x 2 months, dyspnea on exertion x 2 month with acute exacerbation x 1 day prior to presentation. tachycardia, conjunctiva- rim and palmer crease pallor, systolic ejection murmur, chronic constipation, who take daily ASA for cardiac prevention, on medication for hypertension, has history of CAD s/p CABG 8 years ago, Osteoarthritis take NSAID, GERD on PPI

ANSWER

A Comprehensive Medical Diagnosis for a Patient with Racing Heart, Fatigue, Weakness, and Dyspnea: Assessing Cardiac and Non-Cardiac Factors

Introduction

The case of a patient presenting with symptoms such as racing heart, progressive fatigue, generalized weakness, dyspnea on exertion, tachycardia, pallor, systolic ejection murmur, chronic constipation, and a medical history including cardiovascular disease, osteoarthritis, and GERD raises concerns about multiple potential diagnoses. This essay aims to explore the possible medical diagnosis for this patient, taking into account both cardiac and non-cardiac factors that may contribute to the symptoms.

Medical Diagnosis Considerations

Cardiac Factors

Acute Coronary Syndrome (ACS): Given the patient’s history of coronary artery disease (CAD) and the presence of symptoms such as racing heart, dyspnea, and fatigue, ACS should be considered. A recent acute exacerbation and systolic ejection murmur may further support this possibility.

Cardiac Arrhythmias: The racing heart and tachycardia experienced by the patient may be indicative of cardiac arrhythmias, such as supraventricular tachycardia (SVT) or atrial fibrillation (AF). These arrhythmias can cause fatigue and dyspnea on exertion.

Cardiac Medications and Side Effects: The patient’s use of daily aspirin for cardiac prevention and medication for hypertension may contribute to the symptoms. Side effects of these medications, such as anemia due to chronic NSAID use and medication-induced dyspnea, should be considered.

Non-Cardiac Factors

Anemia: The presence of conjunctival pallor and palmar crease pallor suggests the possibility of anemia. Chronic NSAID use, history of CAD, and potential gastrointestinal bleeding could contribute to the development of anemia, leading to fatigue, weakness, and dyspnea.

Chronic Constipation: Chronic constipation may be unrelated to the current symptoms but could indicate an underlying gastrointestinal disorder. It is essential to evaluate any potential impact on the patient’s overall health and well-being.

Osteoarthritis and NSAID Use: The patient’s osteoarthritis and NSAID use may contribute to gastrointestinal symptoms, such as GERD, which could worsen fatigue and dyspnea due to potential reflux-related issues.

Nursing Implications

Comprehensive Assessment: Conduct a thorough assessment, including detailed medical history, physical examination, laboratory tests (e.g., complete blood count, cardiac enzymes), and cardiac investigations (e.g., electrocardiogram, echocardiogram), to evaluate both cardiac and non-cardiac factors.

Collaborative Approach: Collaborate with the healthcare team, including cardiologists, gastroenterologists, and hematologists, to ensure a comprehensive evaluation and diagnosis.

Symptom Management: Implement interventions to address the symptoms and enhance the patient’s overall well-being. This may include adjusting medications, managing anemia (e.g., iron supplementation), addressing constipation, and optimizing cardiac management based on the specific diagnosis.

Conclusion

The presented case involving a patient with racing heart, fatigue, weakness, dyspnea, and various comorbidities requires a comprehensive approach to arrive at an accurate medical diagnosis. Considering cardiac factors, such as acute coronary syndrome and arrhythmias, alongside non-cardiac factors like anemia, chronic constipation, and medication side effects, is crucial. Nursing professionals play a significant role in conducting a thorough assessment, collaborating with the healthcare team, and managing symptoms to ensure optimal care and improve the patient’s overall quality of life.