His father died at age 46 from a heart attack and his mother died at age 56 from a stroke.
John, a 46-year-old African American male, presents to your Emergency Department complaining of severe chest pain. He is highly anxious and fearful, talking rapidly and begging for help. He states he was at a baseball game with his friends when the pain started and he came directly to the ER. His history and assessment include the following.
John is a minister at a fundamentalist Christian church.
John has a sedentary lifestyle and smoked one pack a day for 25 years but quit cold turkey three days ago on his birthday.
BP 170/96, HR 100, RR 24, temp 98.4.
He describes his pain as "sharp, burning" and a 7 on a 1-10 scale. When asked to identify the exact location of the pain, he puts his hand over his epigastric area.
There is no radiation.
What risk factors does John have for cardiovascular disease? Are the vital signs indicative of pain? Is there anything else that could be causing these vital signs? What could be causing the patient to be so fearful and anxious? How could the anxiety be affecting his perception of pain?