Model Answer
0 min readIntroduction
Diagnosis in medicine is a complex process involving the gathering of information through history taking, physical examination, and investigations, followed by a reasoned assessment to identify the nature of a disease or condition. Without a patient presentation, a hypothetical case must be assumed. For the purpose of this answer, we will assume a 55-year-old male presenting with chest pain, shortness of breath, and diaphoresis. These symptoms are highly suggestive of a cardiovascular event, and a rapid, accurate diagnosis is critical for effective management and improved patient outcomes.
Hypothetical Case Presentation
A 55-year-old male presents to the emergency department complaining of severe, crushing chest pain radiating to his left arm. He also reports shortness of breath and profuse sweating (diaphoresis). He has a history of hypertension and smoking. His vital signs reveal a blood pressure of 160/100 mmHg, a heart rate of 110 bpm, and an oxygen saturation of 92% on room air.
Differential Diagnosis
Given the presenting symptoms, the following differential diagnoses were considered:
- Acute Myocardial Infarction (AMI): This is the most likely diagnosis given the classic symptoms of chest pain, radiation, shortness of breath, and diaphoresis, coupled with risk factors like hypertension and smoking.
- Angina Pectoris: While similar to AMI, angina is typically relieved by rest or nitroglycerin. The severity and persistence of the pain in this case suggest AMI.
- Pulmonary Embolism (PE): Shortness of breath and chest pain can occur in PE, but the pain is usually pleuritic (worse with breathing) and less crushing.
- Aortic Dissection: This presents with sudden, severe tearing chest pain, often radiating to the back.
- Esophageal Spasm: Can mimic cardiac chest pain, but is usually associated with swallowing and is not typically accompanied by diaphoresis.
Diagnosis
Acute ST-Elevation Myocardial Infarction (STEMI)
Justification
The diagnosis of STEMI is based on the following factors:
- Clinical Presentation: The patient’s symptoms – severe, crushing chest pain radiating to the left arm, shortness of breath, and diaphoresis – are highly suggestive of AMI.
- Risk Factors: The patient has significant risk factors for coronary artery disease, including hypertension and a history of smoking.
- Vital Signs: Elevated blood pressure and tachycardia are common responses to pain and stress associated with AMI.
- Expected Diagnostic Findings (based on further investigation): An electrocardiogram (ECG) would likely show ST-segment elevation in contiguous leads, confirming STEMI. Cardiac biomarkers (troponin I or T) would be elevated, indicating myocardial damage.
While other diagnoses were considered, they are less likely given the totality of the clinical picture. The severity and nature of the chest pain, coupled with the patient’s risk factors, strongly point towards an acute coronary syndrome, specifically STEMI. Immediate intervention, such as percutaneous coronary intervention (PCI), is crucial to restore blood flow to the affected myocardium and minimize damage.
| Feature | STEMI | Angina | Pulmonary Embolism |
|---|---|---|---|
| Chest Pain | Severe, crushing, radiating | Pressure-like, relieved by rest | Pleuritic, sharp |
| ECG | ST-segment elevation | Normal or ST-segment depression | Sinus tachycardia, S1Q3T3 pattern (sometimes) |
| Cardiac Biomarkers | Elevated | Normal | Elevated BNP (sometimes) |
Conclusion
In conclusion, based on the hypothetical clinical presentation, the most likely diagnosis is Acute STEMI. This diagnosis is supported by the patient’s symptoms, risk factors, and expected diagnostic findings. Prompt recognition and intervention are paramount in managing STEMI to reduce morbidity and mortality. Further investigations, including ECG and cardiac biomarker analysis, are essential to confirm the diagnosis and guide appropriate treatment.
Answer Length
This is a comprehensive model answer for learning purposes and may exceed the word limit. In the exam, always adhere to the prescribed word count.