I HUMAN STEVEN VAN DYKE STUDY CASE 2023,2024 BEST FINDINGS

Steven Van Dyke is a 36-year-old Caucasian male smoker who presents to the ED following the acute onset of nonradiating, nonreproducible chest tightness of >20 minutes duration, symptoms beginning while he was watching TV. He complains of associated palpitations, shortness of breath, choking sensation, dizziness, nausea, sweating, and “fear of having a heart attack.” He reports a 1-month history of similar episodes lasting 5-20 minutes, and now increasing in intensity over the past week. The first episode happened while exercising; subsequent episodes occurred during work-related meetings. This is the first episode occurring at rest outside of the work setting. PMH is significant only for childhood asthma; he denies any history of psychiatric disease. The patient’s father died 2 years ago at age 62 due to an MI. PE reveals an anxious-appearing young male with fidgeting of hands and legs. He is tachycardic and takes deep breaths between speaking in phrases. The cardiopulmonary and neurologic exams are otherwise normal. Primary Diagnosis: Panic Disorder: characterized by episodic, unexpected panic attacks that occur without a clear trigger (American Psychiatric Association, 2013). Attacks have a rapid onset of intense fear with at least four of the physical and psychological symptoms, such as palpitations, sweating, trembling/shaking, sensations of shortness of breath, feelings of choking, chest pain or discomfort, nausea, dizziness, or fear of losing control or dying (Locke, Kirst, & Shultz, 2015). The disorder is not caused by the physiological effects of a substance or undiagnosed medical condition.