Physician's Assistant

Patient Details

Sdec (256 days ago 11:15)

Sdec Thu 24 July 2025 11:15

Last Modified: 256 days ago

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Presenting Complaint:
Chest pain and anxiety

Past Medical History
• Hepatitis C without cirrhosis
• Previous IV drug use
• Pulmonary embolism 2025
• Previous DVT
• COPD
• Recent myocarditis (May 2025)
• Single kidney
• History of heroin use

Diagnosis:
Viral myocarditis with ongoing chest pain and anxiety. Possible viral upper respiratory tract infection.

I had the pleasure of meeting Tracy Gibbons in Same Day Emergency Care today.

Ms Gibbons is a 49-year-old lady who was recently admitted in late May to early June 2025 with bilateral small volume pulmonary emboli and myocarditis. She presented today with a 24-hour history of left-sided chest pain and severe anxiety.

She reports significant psychosocial stressors including her partner's recent release from prison, concerns about her children's substance abuse, and her own recent relapse with crack cocaine use (once in the past 8 weeks). She describes severe anxiety with associated chest pain, palpitations, and muscle tension. The chest pain is located on the left side with associated swelling and muscle soreness around the shoulder blades.

She reports recent viral symptoms including nasal congestion, chills yesterday, and changed sputum production (green and white). She denies fever or sore throat. She continues to experience profuse sweating and has had intermittent shooting pains through the chest.

On examination, the patient appeared anxious but comfortable at rest. Cardiovascular examination revealed clear heart sounds with no added sounds. Respiratory examination showed clear lung fields bilaterally. There was some chest wall tenderness and swelling noted.

Her recent cardiac investigations showed excellent recovery from her previous myocarditis with normalised troponin levels and evidence of cardiac repair on MRI.

Investigations:
Urea 10.2, Creatinine 82, Sodium and potassium normal
LFTs normal
Troponins 14 and 8 (previously 1,300 - now normalised)
D-dimer 0.2
White cells 11.7 with lymphocytes 5.8 (suggesting viral infection)
MRI cardiac myocardial viability study: Signal in anterior and septal regions suggestive of myocardial oedema, no evidence of LV infarction, normal LV volumes
Invasive cardiac catheterisation May 2025: EF 33%, unobstructed coronaries
CT pulmonary angiogram 23/05/2025: Small volume pulmonary emboli bilaterally in segmental arteries
Echocardiogram 26/05/2025: Severely dilated LV with eccentric LVH, severely impaired systolic function EF 33%, mild AR, dilated LA, borderline RA dilatation, normal RV

Plan:
1. Discuss case with cardiology team regarding ongoing chest pain in context of recent viral myocarditis
2. Continue current cardiac medications and anticoagulation
3. Supportive care for viral symptoms
4. Address anxiety and provide appropriate support/referral
5. Smoking cessation support and substance abuse counselling
6. Follow-up arrangements as per cardiology recommendations

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Sdec Thu 24 July 2025 11:15

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