Questions
HISTORY OF PRESENT ILLNESS:
A 49-year-old Hispanic male is referred to you for follow-up after appearing in the emergency center at 1:00 a.m. complaining of chest pain which had started approximately two hours previously. The patient stated that he had similar chest pains in the past, but never sought medical attention for them. The pain was reported in the precordium area, but it did not radiate to the left arm or to the jaw. The patient also complained of headache, which he had had off and on for the past several months. More often than not, the headache did no respond to over-the-counter analgesics.
The patient expressed anxiety about his health problem because he had been very healthy and very active in the past. He had never visited a physician until three years previously when he was in an automobile accident in which he sustained a fracture of the left leg. At that time his blood pressure was found to be elevated and he was referred to a primary care physician, who found evidence of mild congestive heart failure and placed him on an angiotensin converting enzyme (ACE) inhibitor and digitalis. The patient stated that he had experienced decreased libido over the last few months, which he attributed to his medications. He has friends who have reported to him that they experienced decreased libido since starting on hypertension medications. The patient is concerned about early death or disability from his heart condition, but is reluctant to take the prescribed medication.
Family and Social History: The patient is married and has three children of school age (12, 14, and 16 years old). He works as a security guard in a large plant on a rotating shift basis. His wife works as a clerk in a store. The patient's father died of a myocardial infarction at the age of 62, and the mother, who is now 68 years old, is known to have hypertension and diabetes. The patient communicates in English, but preferred to complete the medical history questionnaires in Spanish. The patient does not smoke, reports no physical activity outside of his job, and consumes 2-4 beers on most weekdays, and 5-7 beers on weekends.
Questions