CC
Mrs. Foster 32-year-old female here today with her husband to follow up from the emergency room visit at Portsmouth Hospital for chest pain.
HPI
The patient was seen in the hospital for a similar reason back in March. She reports that the symptoms started very similarly with a pain in her chest area near the sternum. She said, however the pain that she had on September 5th was worse than any pain that she has had in the past. She describes it as a 9/10 on a pain scale. She said she started noticing the pain a little bit around the sternum. It then progressed to go across her chest, into the shoulders and into the back. She felt she was a little bit short of breath with it, as well as a little bit nauseous, and says that she talked …show more content…
Her husband did drive her, though they contemplated calling 911. She said when this was happening, she was in a very stressful situation. Her children were in an argument and she was trying to work with them about that and she does find there are times when the chest pain comes when she is under a lot of stress, particularly related to her kids. When she went to Portsmouth Hospital, she was evaluated there. She had laboratory studies done including cardiac enzymes, which were negative, a metabolic panel, which was normal and a CBC, which was stable. She had an EKG, which was normal and a chest x-ray, which showed no acute process. She was told that this is costochondritis and recommended to take ibuprofen, which she does feel is helpful, at times. She says since then, the pain has not been as bad. It still is coming and going however. She is not noticing the same shortness of breath or nausea that she had previously. She does find that the ibuprofen is useful. She admits that there are times when she has a lot of burping and a sour taste in her mouth, though she would not describe herself as having heartburn. She is a tobacco user, though she reports that she is trying to cut down. She has been a smoker since the age of 16. …show more content…
The fact that she feels more chest pain at times with stressful situations, as well as the potentially reflux type symptoms, I think this is likely multifactorial. She does have reproducible chest pain here in the office that I believe is consistent with costochondritis and we reviewed the treatment here again. In addition, I have asked her to try a trial of omeprazole 20 mg one p.o. daily #30 with no refills and reviewed the use and side effects with her. We will assess in about a month to see how that is going. In addition, we talked about the stress that she is under. We talked about the possibility of counseling or psychiatry, which she declines for now. Medication was declined as well. This is something we can discuss in the future. Stress reduction techniques were discussed. The patient has also had some palpitations. I would like for her to wear a Holter monitor and I will review the results with her when available. At that point, we will make a decision about what to do further. Should she have increased problems or concerns in the meantime, she will follow up sooner or seek care if necessary in the meantime. In addition, patient counseled regarding tobacco
Mrs. Foster 32-year-old female here today with her husband to follow up from the emergency room visit at Portsmouth Hospital for chest pain.
HPI
The patient was seen in the hospital for a similar reason back in March. She reports that the symptoms started very similarly with a pain in her chest area near the sternum. She said, however the pain that she had on September 5th was worse than any pain that she has had in the past. She describes it as a 9/10 on a pain scale. She said she started noticing the pain a little bit around the sternum. It then progressed to go across her chest, into the shoulders and into the back. She felt she was a little bit short of breath with it, as well as a little bit nauseous, and says that she talked …show more content…
Her husband did drive her, though they contemplated calling 911. She said when this was happening, she was in a very stressful situation. Her children were in an argument and she was trying to work with them about that and she does find there are times when the chest pain comes when she is under a lot of stress, particularly related to her kids. When she went to Portsmouth Hospital, she was evaluated there. She had laboratory studies done including cardiac enzymes, which were negative, a metabolic panel, which was normal and a CBC, which was stable. She had an EKG, which was normal and a chest x-ray, which showed no acute process. She was told that this is costochondritis and recommended to take ibuprofen, which she does feel is helpful, at times. She says since then, the pain has not been as bad. It still is coming and going however. She is not noticing the same shortness of breath or nausea that she had previously. She does find that the ibuprofen is useful. She admits that there are times when she has a lot of burping and a sour taste in her mouth, though she would not describe herself as having heartburn. She is a tobacco user, though she reports that she is trying to cut down. She has been a smoker since the age of 16. …show more content…
The fact that she feels more chest pain at times with stressful situations, as well as the potentially reflux type symptoms, I think this is likely multifactorial. She does have reproducible chest pain here in the office that I believe is consistent with costochondritis and we reviewed the treatment here again. In addition, I have asked her to try a trial of omeprazole 20 mg one p.o. daily #30 with no refills and reviewed the use and side effects with her. We will assess in about a month to see how that is going. In addition, we talked about the stress that she is under. We talked about the possibility of counseling or psychiatry, which she declines for now. Medication was declined as well. This is something we can discuss in the future. Stress reduction techniques were discussed. The patient has also had some palpitations. I would like for her to wear a Holter monitor and I will review the results with her when available. At that point, we will make a decision about what to do further. Should she have increased problems or concerns in the meantime, she will follow up sooner or seek care if necessary in the meantime. In addition, patient counseled regarding tobacco