Case of Cardiology

[Qooryare]

A 62-year-old Caucasian male (CM) is admitted to the hospital with a chief complaint (CC) of lower chest pain and epigastric pain for 6 hours.

The abdominal pain is reminiscent of an episode of pancreatitis 5 years ago. The chest discomfort is intermittent and occurs with deep inspiration, described as "pressure like". The abdominal pain is sharp and burning in nature and there are no other associated symptoms. The patient reports no radiation, nausea, vomiting, diarrhea or constipation (N/V/D/C), shortness of breath (SOB) or sweating. The onset of the symptoms was during rest and light activity. The pain is described as 5/10 on 0-10 scale.

One approach to the work-up the chief complaint (CC) by asking some questions using the mnemonic SOCRATESSS:

Site
Onset
Character
Radiation
Alleviating factors
Timing
Exacerbating factors
Severity 1-10
Similar symptoms
Sx

Past medical history (PMH)

Diabetes type 2 (DM 2), pancreatitis, hypertension (HTN), peripheral vascular disease (PVD).

Medications

Actos (pioglitazone), pentoxifylline (Trental), atenolol, triamterene and hydrochlorothiazide (Maxzide, Dyazide).

Social history (SH)

No smoking, drugs or alcohol.

Family medical history (FMH)

Noncontributory.

What is the most likely diagnosis?
mention other causes?

It could be coronary artery disease (CAD). Ischemia should be the first thing on your mind. He is a diabetic, not on aspirin (ASA) and is at high risk for acute ischemia.

Other causes?
Pancreatitis
Peptic ulcer disease (PUD)
Pneumonia and pleurisy are less likely causes without (w/o) cough, fever or chills
Hepatitis due to nonalcoholic steatohepatitis (NASH) or Actos (pioglitazone)?
Ischemic bowel?