Gathering important diagnostic information

What questions would you ask to gather important diagnostic information? Robert Ross is a 17-year-old athletic male who presents to the ED with a 6-hour history of acute chest pain, accompanied by palpitations, shortness of breath, and fever. His current symptoms were preceded by a 1-week course of viral URI symptoms, including subjective fevers, chills, malaise, and significantly decreased exercise tolerance. PMH is otherwise unremarkable. Per exam, Robert is tachypneic and manifests moderate distress secondary to chest pain. There is no JVD; PMI is nondisplaced. Cardiac auscultation reveals tachycardia with occasional extra beats, but no evidence of murmur, gallop, or rub. The lungs are clear bilaterally; abdominal and extremity exams are unremarkable. Important Diagnostic Tests results: 1) Normal D Dimer 2) Abnormal 12 lead ECG Synus Tachycardia (140), No ST elevations, No ST depression, T wave inversion in lead I and aVL. 3) Elevated troponin. 4) Abnormal echocardiogram, thickened septal walls. Main Diagnosis: Myocarditis. Differential diagnoses: 1) Pulmonary Embolism. 2) Pneumonia. 3) Acute Coronary Syndrome. • What questions would you ask to gather important diagnostic information? • How would you diagnose and manage this 17-year-old male whose symptoms include palpitations, fever and malaise? • Which diagnostic studies would you recommend for this patient. Include the rationale for ALL diagnostics and Labs? • What physical exam findings and diagnostic results would be concerning to you and why? What would be three differentials in this case? Identify additional life-threatening diagnoses that must be considered when a patient presents with acute chest pain. What is the treatment (including rationale) for Robert and education for the family?      

Sample Solution