49-year-old female presents today with complaints of exertional mid- chest pain that has been occurring for the past 2 weeks. The patient describes the pain as a “squeezing feeling” that radiates to her left arm while she was cross country skiing in extreme cold weather. The patient states that the pain worsens in cold weather and is accompanied by dyspnea that is only alleviated with rest. The patient reports the chest pain to be moderate and reports a 6/10 on a pain scale when episodes occur. The patient reports a history of hypertension and hypercholesterolemia and reports a family history of heart disease. Upon physical examination, the patient is slightly overweight with a BMI of 25.5 but has a normal physical examination.
Use the expert diagnosis (Stable Angina provided to create a pertinent, comprehensive, evidenced-based management plan.
Address the following criteria in the plan:
1.) Diagnostic tests;
2.) Medications (write out a complete order, even for OTC meds); HCTZ 12.5mg
3.) Suggested consults/referrals;
4.) Patient education
5.) Follow-up, including time interval and specific symptoms to prompt a return visit sooner;
6.) Provide rationales for each intervention and include references to support your plan. Clinical practice guidelines should be utilized as applicable.
CC: Intermittent squeezing chest pain • MSAP: Exertional “squeezing” mid-chest pain radiating to left arm, relieved by rest, worse with cold • Associated dyspnea on exertion • History: HLD, HTN, previous smoker, family hx of heart disease • Stressful work