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Case Chest Pain

6 min read

Table of Contents

  • Case Studies
    • Case-3: Chest Pain
      • Patient Brief Record / Brief Scenario
        • Information for Student about the Case
        • Task: What is Expected from a Student?
      • Patient Brief Record / Brief Scenario
        • Information for the Simulated Patient
        • Important Notes for the Simulated Patient
    • Case-3: Chest Pain Checklist
      • Students Should Perform These Tasks

Case Studies

Case-3: Chest Pain

Patient Brief Record / Brief Scenario

Information for Student about the Case

  • Patient Name: Ahmad
  • Age: 50 years
  • Occupation: Employee at a private company
  • Today BP: 150/90 mm Hg
  • Weight: 90 kg
  • Height: 170 cm

Mr. Ahmad is a 50-year-old man who came today with the complaint of chest pain on and off over the past few weeks.

Task: What is Expected from a Student?

  • Take a focused history to reach a probable diagnosis.
  • Examine the cardiovascular system.
  • Inform the patient about the possible diagnosis.
  • Give appropriate advice regarding lifestyle modification.
  • Explain to the patient the management plan.

Patient Brief Record / Brief Scenario

Information for the Simulated Patient

  • Patient Name: Ahmad
  • Age: 50 years
  • Occupation: Employee at a private company
  • Marital Status: Married, with 2 children (18 and 20 years old).

You are a 50-year-old man who works as an employee at a private company. For the past few weeks, you have been experiencing on-and-off chest pain.

Opening Scenario: “I have chest pain, doctor.” (You will admit only this information).

Tell your doctor about the following information only if specifically asked about:

  • Complaint of chest pain over the past few weeks.
  • Pain usually comes on exertion, especially when climbing stairs.
  • No history of trauma.
  • You smoke 20 cigarettes per day.
  • You have gained about 10 kg in the past 6 months.
  • You are generally well apart from this chest pain.
  • Your working hours are 8:00 AM to 5:00 PM.
  • Some stress at work when you have to do too much paperwork.
  • No stress at home.
  • Your BP was taken by the nurse today and was told to be slightly high and repeated twice.
  • Sedentary lifestyle, and no regular exercise.
  • Your father died of a heart attack at the age of 55 years.
  • Your mother is diabetic and hypertensive.
  • Patient’s Idea: Possibly hypertension.
  • Concern: Heart attack, as your father.
  • Expectation: To confirm the diagnosis of hypertension to start treatment.

SAY NO TO ANY OTHER QUESTIONS RELATED TO ANY SYMPTOMS.

Important Notes for the Simulated Patient:

  • The doctor will examine your chest to confirm the diagnosis.

Case-3: Chest Pain Checklist

Students Should Perform These Tasks:

  1. Professional Behavior

    • Introduces himself and gets permission to take history.
    • Starts with an open-ended question.
    • Develops rapport with the patient.
    • Does not interrupt.

  2. History Taking Skills

    • Explore the problem, character, site, and severity to differentiate between cardiac and non-cardiac causes.
    • Explore other related risk factors to detect cardiovascular disease (CVD) risk factors.
    • Personal and social history:
      • Smoking.
      • Lack of exercise, diet, alcohol, etc.
    • Family history of CVD, history of premature death.
    • Appropriate history to exclude stress at home and work.
    • Patient’s idea, concern, and expectation are explored and dealt with well.

  3. Clinical Examination

    • General Examination:
      • Vital signs.
      • Cardiovascular system examination.

  4. Management

    • Explains the problem to the patient in a simple way.
    • Informs the patient about the possibility of hypertension, ischemic heart disease, and being at high risk.
    • Stresses premature death in the family and diabetes mellitus (DM) & hypertension (HTN).
    • Dietary advice and other non-pharmacological advice.
    • Arrives at a shared understanding.
    • Invites questions from the patient.
    • Summarizes at the end of the consultation.
    • Appropriate education and counseling about lifestyle.
    • Measures to decrease weight, such as walking and dieting.
    • ECG and possibility of starting antianginal treatment.
    • Offers investigations: CBC, renal functions, lipid profile, FBS, possibility of echo, etc.
    • Follow-up visit to check BP and investigations and start treatment.

chest pain students

Table of Contents

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Case Studies

Case-3: Chest Pain

Patient Brief Record / Brief Scenario

Information for Student about the Case

  • Patient Name: Ahmad
  • Age: 50 years
  • Occupation: Employee at a private company
  • Today BP: 150/90 mm Hg
  • Weight: 90 kg
  • Height: 170 cm

Mr. Ahmad is a 50-year-old man who came today with the complaint of chest pain on and off over the past few weeks.

Task: What is Expected from a Student?

  • Take a focused history to reach a probable diagnosis.
  • Perform a cardiovascular system examination.
  • Inform the patient about the possible diagnosis.
  • Give appropriate advice regarding lifestyle modification.
  • Explain to the patient the management plan.

Patient Brief Record / Brief Scenario

Information for the Simulated Patient

  • Patient Name: Ahmad
  • Age: 50 years
  • Occupation: Employee at a private company
  • Marital Status: Married, with 2 children (18 and 20 years old).

You are a 50-year-old man who works as an employee at a private company. For the past few weeks, you have been experiencing on-and-off chest pain.

Opening Scenario:

“I have chest pain, doctor.” (You will admit only this information.)

Tell your doctor about the following information only if specifically asked about:

  • Complaint of chest pain over the past few weeks.
  • Pain usually comes on exertion, especially when climbing stairs.
  • No history of trauma.
  • You smoke 20 cigarettes per day.
  • You have gained about 10 kg in the past 6 months.
  • You are generally well apart from this chest pain.
  • Your working hours are 8:00 AM to 5:00 PM.
  • Some stress at work when you have to do too much paperwork.
  • No stress at home.
  • Your BP was taken by the nurse today and was found to be slightly high, repeated twice.
  • Sedentary lifestyle, and no regular exercise.
  • Your father died of a heart attack at the age of 55 years.
  • Your mother is diabetic and hypertensive.

Patient’s Idea: Possibly hypertension.

Concern: Heart attack, as your father.

Expectation: To confirm the diagnosis of hypertension to start treatment.

SAY NO TO ANY OTHER QUESTIONS RELATED TO ANY SYMPTOMS.

Important Notes for the Simulated Patient:

  • The doctor will examine your chest to confirm the diagnosis.

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