Final Answer:
The patient presents with acute pleuritic chest pain, tachypnea, borderline tachycardia, a history of smoking, OCP use, and a family history of CAD. Given these symptoms and risk factors, the primary concern is a pulmonary embolism (PE). Immediate evaluation for PE, including imaging studies like a CT pulmonary angiogram, is crucial for accurate diagnosis and prompt initiation of anticoagulant therapy.
Step-by-step explanation:
The constellation of symptoms—pleuritic chest pain, tachypnea, tachycardia, and risk factors such as smoking, OCP use, and a family history of CAD—raises suspicion of a pulmonary embolism (PE). To confirm this diagnosis, imaging studies, especially a CT pulmonary angiogram, are essential. The clinical decision rule, such as the Wells score, can aid in risk stratification for PE likelihood. Calculations using this score may include assigning points for clinical features like tachycardia, signs of DVT, and other risk factors. These scores help guide the necessity and urgency of imaging studies.
Considering the potential life-threatening nature of PE, prompt diagnosis and treatment initiation are paramount. Delay in diagnosis can lead to complications like right heart strain, pulmonary infarction, or even death. The patient's history of OCP use increases the risk of thromboembolic events, reinforcing the urgency of ruling out PE. Management involves anticoagulation therapy, balancing the risks of bleeding against the benefits of preventing further embolic events.
In summary, the patient's presentation aligns with a high suspicion for PE due to the combination of symptoms and risk factors. Immediate imaging and treatment initiation are crucial to confirm the diagnosis and prevent potential complications. The utilization of clinical decision rules aids in risk stratification, guiding the urgency of imaging studies for accurate diagnosis.