NR603 Week 6 Assignment: Clinical Education Associated
(CEA) Pre-Diagnostic Exam Case Study Part 2
General Instructions
This assignment builds on the case study in this week’s collaboration café. Carefully read the
assignment guidelines and rubric and complete each case study section below. Use of this
template is required.
Differential Diagnoses:
Stable Angina (Chronic Coronary Syndrome), Acute Coronary Syndrome (Unstable
Angina/NSTEMI), Gastroesophageal Reflux Disease (GERD).
Diagnosis 1: Stable Angina (Chronic Coronary Syndrome)
Pathophysiology:
Stable angina occurs when myocardial oxygen demand exceeds supply due to atherosclerotic
narrowing of the coronary arteries. The resulting myocardial ischemia is transient and typically
occurs with exertion or stress, resolving with rest or nitroglycerin.
Rationale:
J.T. presents with exertional, pressure-like chest pain radiating to the left arm and relieved by
rest. His risk factors (age, male sex, hypertension, hyperlipidemia, and smoking history) and
classic symptoms strongly support stable angina.
,Diagnosis 2: Acute Coronary Syndrome (Unstable Angina/NSTEMI)
Pathophysiology:
ACS results from acute plaque rupture or erosion in a coronary artery, causing partial or
complete thrombosis. This leads to sudden, reduced myocardial perfusion, which may progress
to myocardial infarction if not promptly treated.
Rationale:
The pressure-like chest pain, associated diaphoresis, and risk factors raise concern for
unstable angina or NSTEMI, especially given the recent onset and crescendo pattern. ACS
must always be excluded in patients with new or changing angina symptoms.
Diagnosis 3: Gastroesophageal Reflux Disease (GERD)
Pathophysiology:
GERD occurs due to the reflux of gastric contents into the esophagus, leading to irritation and
inflammation. This can cause chest pain that may mimic cardiac origin, especially in older
adults.
Rationale:
, GERD is a common non-cardiac cause of chest pain and may present similarly to angina. It
should be considered, especially if cardiac causes are ruled out, as GI symptoms can overlap
with cardiac presentations in older adults.
Differential Diagnoses Comparative and Contrastive Analysis (Discuss how the three
differential diagnoses are similar and different in occurrence, pathophysiology, and
presentation.)
Comparison and Contrast of Occurrence:
Stable angina and acute coronary syndrome (ACS) primarily occur in individuals with
established cardiovascular risk factors such as advanced age, male sex, hypertension,
hyperlipidemia, and a history of tobacco use (Gulati et al., 2021; Virani et al., 2023). Stable
angina commonly presents in patients with longstanding atherosclerotic disease, while ACS may
occur more abruptly due to acute plaque rupture or thrombosis. Gastroesophageal reflux disease
(GERD), by contrast, is prevalent across a broad adult population, with increased occurrence in
individuals over 40 years of age, those with obesity, and those exposed to dietary or lifestyle risk
factors. Unlike angina and ACS, GERD is not sex-specific and can affect both males and
females equally.
Comparison and Contrast of Pathophysiology:
(CEA) Pre-Diagnostic Exam Case Study Part 2
General Instructions
This assignment builds on the case study in this week’s collaboration café. Carefully read the
assignment guidelines and rubric and complete each case study section below. Use of this
template is required.
Differential Diagnoses:
Stable Angina (Chronic Coronary Syndrome), Acute Coronary Syndrome (Unstable
Angina/NSTEMI), Gastroesophageal Reflux Disease (GERD).
Diagnosis 1: Stable Angina (Chronic Coronary Syndrome)
Pathophysiology:
Stable angina occurs when myocardial oxygen demand exceeds supply due to atherosclerotic
narrowing of the coronary arteries. The resulting myocardial ischemia is transient and typically
occurs with exertion or stress, resolving with rest or nitroglycerin.
Rationale:
J.T. presents with exertional, pressure-like chest pain radiating to the left arm and relieved by
rest. His risk factors (age, male sex, hypertension, hyperlipidemia, and smoking history) and
classic symptoms strongly support stable angina.
,Diagnosis 2: Acute Coronary Syndrome (Unstable Angina/NSTEMI)
Pathophysiology:
ACS results from acute plaque rupture or erosion in a coronary artery, causing partial or
complete thrombosis. This leads to sudden, reduced myocardial perfusion, which may progress
to myocardial infarction if not promptly treated.
Rationale:
The pressure-like chest pain, associated diaphoresis, and risk factors raise concern for
unstable angina or NSTEMI, especially given the recent onset and crescendo pattern. ACS
must always be excluded in patients with new or changing angina symptoms.
Diagnosis 3: Gastroesophageal Reflux Disease (GERD)
Pathophysiology:
GERD occurs due to the reflux of gastric contents into the esophagus, leading to irritation and
inflammation. This can cause chest pain that may mimic cardiac origin, especially in older
adults.
Rationale:
, GERD is a common non-cardiac cause of chest pain and may present similarly to angina. It
should be considered, especially if cardiac causes are ruled out, as GI symptoms can overlap
with cardiac presentations in older adults.
Differential Diagnoses Comparative and Contrastive Analysis (Discuss how the three
differential diagnoses are similar and different in occurrence, pathophysiology, and
presentation.)
Comparison and Contrast of Occurrence:
Stable angina and acute coronary syndrome (ACS) primarily occur in individuals with
established cardiovascular risk factors such as advanced age, male sex, hypertension,
hyperlipidemia, and a history of tobacco use (Gulati et al., 2021; Virani et al., 2023). Stable
angina commonly presents in patients with longstanding atherosclerotic disease, while ACS may
occur more abruptly due to acute plaque rupture or thrombosis. Gastroesophageal reflux disease
(GERD), by contrast, is prevalent across a broad adult population, with increased occurrence in
individuals over 40 years of age, those with obesity, and those exposed to dietary or lifestyle risk
factors. Unlike angina and ACS, GERD is not sex-specific and can affect both males and
females equally.
Comparison and Contrast of Pathophysiology:
