Cardiovascular Assessment

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Cardiovascular Assessment of patients presenting with chest pain in Primary Care. It is often a difficult task to ascertain whether chest pain is of a cardiac or non cardiac cause in primary care. A fifty year old male presents with chest pain in the pharmacy, as a pharmacist it is important to consider the various types and degrees of chest discomfort that the patient may be experiencing and therefore decide the different assessment approaches that must be taken. Most chronic cardiac diseases tend to be initially asymptomatic however; this should not automatically exclude non chronic conditions which also need to be taken into consideration hence the need for assessment. Conditions that cause chest pain or discomfort,…show more content…
Endoscopy is usually indicated in patients with these symptoms who are older than 45 and have failed to respond to treatment with histamine 2 receptor antagonists (H2 Ant) and proton pump inhibitors (PPIs) . Chest pain is of particular concern as cardiac symptoms can be very similar in presentation and character with oesophageal reflux and Angina Pectoris. The pharmacist should also note that abnormal gastric reflux of stomach contents in Gastro-Oesophageal Reflux (GORD) may in some cases cause extra-oesophageal symptoms such as cough, dental erosions, pharyngitis, sinusitis, idiopathic pulmonary fibrosis, and recurrent otitis media. These should be considered in the differential diagnosis of this…show more content…
This is a sharp or stabbing pain that is commonly accentuated by exertion, respiration and changes in posture such as leaning forward, it may be worse when lying down but pain is relieved when sitting up. This type of pain tends to occur after (MI), viral infections and thoracic radiotherapy. If the pharmacist thinks that the patient may be suffering from this condition they are advised to consider immediate referral to hospital, especially if there is the possibility of acute myocardial infarction (MI) or pulmonary embolism (PE), which may present with similar features. The pharmacist should examine the patient using some of the questions mentioned in the previous initial assessment flowchart. The main alarm features that the pharmacist should look out for are symptoms of cardiac tamponade or constrictive pericarditis such as rapidly rising intra-pericardial pressure, haemorrhage and hypotension with low pulse pressure. An ECG can be carried out on the patient. Based on the results of this ECG, the patient may be referred to a cardiologist (Map of Medicine: Pericardial Disease,2011). Aortic dissection is a condition where a linear tear in the wall of the aorta occurs. It is called an Acute dissection. Predisposing factors that the pharmacist should be aware of may include hypertension. Although rare, this condition may cause very severe and central chest pain of sudden onset. The pain often radiates to the back and down the

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