[52F] Experiencing chest pain, lightheadedness, and difficulty breathing
Patient Description
A 52-year-old female reports severe lightheadedness, sharp chest pain radiating to the back, and difficulty breathing, all persisting for a few days. The lightheadedness is particularly severe, rated 8 out of 10, and is alleviated somewhat by moving around. The chest pain, which makes breathing difficult, is rated 6 out of 10. The patient has no history of similar respiratory symptoms. She is in remission from breast cancer since July 2023 and is currently taking Lisinopril 40 mg. No known drug allergies or adverse reactions to medications have been reported.
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Arora's Assessment
Lightheadedness
Differential diagnosis
- Orthostatic hypotension (I95.1) is likely given the symptom occurs upon standing.
- Other possibilities include dehydration (E86.0), anemia (D64.9), and side effects from Lisinopril (T88.7).
Plan
Check orthostatic blood pressure measurements. Order a CBC to check for anemia and a BMP to assess hydration status. Review the patient's medication regimen, specifically Lisinopril, and consider adjusting the dosage or switching to a different medication if necessary.
Chest Pain and Shortness of Breath
Differential diagnosis
- Given the patient's history of breast cancer, metastasis to the lungs (C78.01) or pleura (C78.2) should be considered.
- Other possibilities include angina (I20.9), myocardial infarction (I21.9), pulmonary embolism (I26.99), and pleurisy (R09.1).
Plan
Order an EKG and troponin levels to rule out cardiac causes. A chest X-ray or CT scan should be performed to assess for lung metastasis, pulmonary embolism, or other lung conditions. If these tests are inconclusive, consider a referral to a cardiologist or pulmonologist for further evaluation.
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11 mo ago