Final answer:
A 68-year-old male with substernal chest pressure radiating to the left shoulder, low blood pressure, and a family history of heart attack may be experiencing an acute myocardial infarction or angina, despite the absence of personal history of cardiovascular risk factors.
Step-by-step explanation:
Potential Considerations for Substernal Chest Pressure
A 68-year-old male presenting with substernal chest pressure radiating to the left shoulder should raise immediate concerns for a possible cardiac event, specifically an acute myocardial infarction (MI). Additionally, the patient's hypotension indicated by a blood pressure of 90/48 could be a sign of cardiogenic shock. Given this patient's family history of heart attack, despite no personal history of heart disease, diabetes, or hypertension, there is still a significant risk factor for coronary artery disease. Angina is another potential condition, characterized by chest pain due to ischemia; however, the fact that symptoms are radiating and accompanied by moderate anxiety raises the likelihood of an MI.
While the patient is not presenting typical hypertensive numbers, the low blood pressure could signify a compromised cardiac output. Despite differences in symptom presentation between sexes, the patient's manifestations are classic for a male experiencing an MI. A diligent diagnosis is crucial, as some symptoms of an MI can mimic less serious conditions like indigestion or anxiety attacks. Since up to 64 percent of MIs can be asymptomatic, the current symptomatic presentation must be addressed with urgency.