The patients high intake of fried foods may be a

cups of coffee a day which can contribute to GERD. The patient’s high intake of fried
foods may be a precipitating factor as the high fat content causes symptoms to occur
postprandially. The supine position exacerbates heartburn which Mr. Brooks has been
experiencing recently.
2) Hiatal Hernia- Is a possible diagnosis because it causes pain in the epigastrium to lower
chest. It also worsens in the supine position. It is also associated with obesity. Physical
examination is typically normal with hiatal hernias though if large enough dullness on
percussion over the left lung base or bowel sounds in the chest may be present. This is
not likely the diagnosis as antacids would not relieve the pain. If the patient failed a PPI
trail and an endoscopy exam was negative then a barium swallow study may be indicated.
3) Functional heartburn- May be a diagnosis for Mr. Booth as the symptoms are similar to
heartburn associated with GERD but are not related. A physical exam is normal just as
with GERD and a hiatal hernia. However, an endoscopic exam and pH monitoring would
both show normal findings.
4) Dyspepsia- May also be a possible diagnosis based on the epigastric burning postprandial
However, epigastric tenderness may be present and burning pain is confined to the
epigastrium. Heartburn is a symptom of dyspepsia but not the predominate symptom.
Other symptoms of dyspepsia include abdominal bloating, nausea, vomiting, belching,
and early satiation which were not present with Mr. Booth.
5) Stable angina- Causes chest pain which could be considered heartburn and therefore a
possible diagnosis. Mr. Booth stated that he has been recently experiencing stress related
to his job. Stress can cause the onset of stable angina and exacerbate it will continued
exposure. Stable angina should be considered if diagnostic studies are all normal,
including endoscopic exam. However, there are other factors that are not present with Mr.
Booth such as radiation of pain to the left shoulder and arm, neck, or jaw. Physical
findings include possible shortness of breath, diaphoresis and a transient S4 gallop when
pain is present. An ECG during an episode of pain may confirm or rule out stable angina.
References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel's guide to
physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical
diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.
Richter, J. E. (2011). Advances in GERD: diagnosis and management of esophageal chest pain.
Gastroenterology & Hepatology , 7 (1), 50-51 2p. Retrieved from Walden Library
databases.