The obvious cardiac risk factors are a family history of a father that died of a heart attack at 46, a mother who died of a stroke at 56, his sedentary lifestyle, and smoking a pack a day for twenty-five years. Elevated vitals are indicators of pain, sharp; burning pain in the epigastric area is worrisome of a possible heart attack.
However, negating factors leaning me towards an anxiety attack are that he may be experiencing anxiety due to the fact that his father died at 46 of a heart attack and now he is 46. This may be causing him stress leading to anxiety. His physical indicators of stress are his increased heart rate, elevated blood pressure, and increased rate of respirations are all signs of stress (D'Amico, & Barbarito, 2012, p. 81). Asking questions such as when did the pain start, what medications is he on, has he had high blood pressure before, has the pain occurred before… Asking questions “the interview” is part of the assessment and will help the nurse have a focus. Once the patient relaxes does the pain subside; with an anxiety attack the pain may lessen, while with a heart attack it will not. Also, withdrawing from nicotine could be a cause of his anxiety. He quit three days ago which is when withdrawal from nicotine peaks (National Library of Medicine, 2012).
D'Amico, D., & Barbarito, C. (2012). Health & physical assessment in nursing (2nd ed.). Upper Saddle River, NJ: Prentice Hall.
National Library of Medicine. National Institutes of Health, (2012). Nicotine and tobacco. Retrieved from website: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001949/?report