AANP Family Nurse Practitioner (FNP) Certification ExamDiagnosisEasy
A 52-year-old male presents to the clinic with a chief complaint of sudden onset of severe, crushing chest pain radiating to his left arm and jaw. He reports associated diaphoresis, shortness of breath, and nausea. His past medical history includes hypertension and hyperlipidemia. On examination, his blood pressure is 150/90 mmHg, heart rate 105 bpm, and respiratory rate 22 bpm. ECG shows ST-segment elevations in leads II, III, and aVF. Which of the following is the most appropriate initial diagnosis?
- AAcute Myocardial Infarction
- BAngina Pectoris
- CEsophageal Spasm
- DPericarditis
Show answer & explanationAnswer & explanation
Correct answer: A. Acute Myocardial Infarction
The patient's classic symptoms of severe, crushing chest pain radiating to the left arm and jaw, along with diaphoresis, shortness of breath, and nausea, combined with ECG findings of ST-segment elevations, are highly indicative of an acute myocardial infarction (heart attack).
Why the other options are wrong
- B. Angina pectoris is typically exertional chest pain relieved by rest or nitroglycerin, and usually does not present with ST-segment elevations unless unstable.
- C. Esophageal spasm can cause chest pain, but it is less likely to be severe and crushing, and would not typically present with the described ECG changes or systemic symptoms like diaphoresis.
- D. Pericarditis typically presents with sharp, pleuritic chest pain that is relieved by leaning forward, and ECG changes are usually diffuse ST-elevations without reciprocal depressions.
Acute Myocardial Infarction (AMI)
A serious condition where blood flow to a part of the heart muscle is blocked, causing heart tissue to die. It is often characterized by severe chest pain and specific ECG changes.
- Caused by prolonged ischemia, usually from coronary artery occlusion.
- Classic symptoms include crushing chest pain, radiation to arm/jaw, dyspnea, diaphoresis.
- ECG shows ST-segment elevation (STEMI) or T-wave inversion/ST-depression (NSTEMI).
Memory trick: CRUSH-D: Crushing pain, Radiation, Unstable, ST-elevation, History, Diaphoresis.