heart attack s/s for cognitively challenge population

[cddris]

I work with cognitively, socailly and medically challenged adults.  I have a 50 yr old Down syndrome female with hx of ulcer, heart murmur, Aortic Stenosis, GERD and a Thyroid conditions.  She comes into my office everyday with c/o chest pain and says she's having a heart attack or similar.  She is communicative, and one of the higher functioning females in the program.  But she tends to complain about every scratch, bruise or even sunburn she gets.  She has never appeared in any respiratory distress.  I take her B/P and Pulse, even SPO2-but I am not sure when I would know for sure she is experiencing something of true concern and not just GERD or anxiety.  Is there a B/P or HR or SPO2 that would indicate she is probably experiencing a Heart Attack or similar.

[Midijane]

A proper clinical evaluation is most definitely needed. You don't want any issues to get worse in time to the point where permanent damage could be done. You'll never know without looking further into this.
Marell

[oldtrout466]

I absolutely agree with livingin hope. Any of the rest of us would expect to have an evaluation of worrying Sx esp with a pre-existing heart condition. she desrves to see a cardiologist -and even if anxiety is a component, repeatedly presenting to you is perhaps her way of expressing it.

[LivingInHope]

You don't know it is anxiety, GERD or esophageal spasms, costochondritis, or heart pain when someone comes in complaining of chest pain.  That's why you need to get physicians to properly evaluate her.

  If the doctor doesn't determine the cause is musculoskeletal in nature (like the pin-pointed pain of costochondritis they can discover with palpation) causing these chest pains, a proper work-up including EKG & blood tests to rule out heart attack is in order... and a nuclear medicine stress test if those come out okay to try to see if she is having angina due to a blockage.  

You mention she has heart murmur and aortic stenosis.  When was the last time she had an echocardiogram to check on the murmur to see if it is any worse than the last time?  The fact she has aortic stenosis (narrowing) is a big reason to take her complaint of chest pain very seriously.  Please, you don't want to limit it to taking her blood pressure, her heart rate or her oxygen level in her finger.

If all heart tests come back normal, is she taking GERD medication?  If she is, a GI specialist should be consulted to try to determine if she needs to change medications or why she is still have GERD symptoms that are giving her pain, if it is GERD causing it.

Please see this journal post I did some time back:
http://www.medhelp.org/user_journals/show/315540/To-all-the-medical-doctors-who-might-read-this