Chest Pain - OSCE history taking for Medical Students | Drs Manual

Summary

In the provided transcript, a 55-year-old patient recounts experiencing severe chest pain that prompted an emergency hospital visit. The pain, described as a pressure and lasting 40 minutes, was alleviated by ambulance-administered painkillers. The patient expresses concern, recalling his father's similar symptoms leading to a heart bypass surgery. The medical team discusses potential causes, rules out some differential diagnoses, and plans further investigations to determine the cause of the chest pain.

Takeaways

• 👤 The patient is a 55-year-old male who was experiencing severe chest pain and was brought to the hospital by an ambulance.
• 🚑 The chest pain episode lasted approximately 40 minutes and was the first time the patient had experienced such pain.
• 💔 The pain was described as a pressure on the chest, moving to the arm and neck, and was constant throughout the 40-minute period.
• 🆘 The patient rated the pain as severe, between 8 and 9 on a scale of zero to ten, with ten being the worst.
• 💊 The patient was given painkillers by the ambulance, which provided some relief.
• 🤔 The patient is concerned about the possibility of a heart attack, as his father had a similar experience at the same age and required bypass surgery.
• 🏥 The patient has a history of high blood pressure and is currently on medication (Ramipril), but readings have been high recently.
• 🍽 The patient experiences heartburn and takes Gaviscon for it, but the chest pain felt different from the usual heartburn.
• 🚭 The patient has been smoking for 25 years, about half a pack a day.
• 🥃 The patient drinks alcohol occasionally, mainly on weekends, with one or two glasses of wine.
• 🏠 The patient's family history includes heart problems (father's heart attack) and diabetes (mother's condition).

Q & A

What was the patient's main complaint?

The patient experienced severe chest pain that started suddenly in the morning and lasted for about 40 minutes.

How did the patient describe the chest pain?

The patient described the chest pain as feeling like someone sitting on his chest, a pressure or a crushing sensation.

Did the chest pain radiate to other areas?

Yes, the pain radiated to the patient's arm and neck, but did not move to the back.

How long did the chest pain last before the patient was taken to the hospital?

The chest pain lasted for about 40 minutes before the ambulance arrived and administered painkillers.

What was the patient's initial reaction to the painkillers?

The patient reported that the painkillers helped quite a bit in alleviating the chest pain.

Has the patient experienced similar chest pain before?

No, this was the first time the patient had experienced chest pain of this nature.

What was the patient's family history of heart conditions?

The patient's father had a heart attack at around the same age and had to undergo bypass surgery.

What other health conditions does the patient have?

The patient has high blood pressure and high cholesterol, for which he takes ramipril, a statin, and gaviscon for heartburn.

Does the patient have any lifestyle habits that could impact his health?

The patient smokes about half a pack of cigarettes a day and drinks alcohol occasionally on weekends.

What was the patient's level of concern regarding the chest pain?

The patient was quite worried about the chest pain, especially considering his father's history of a heart attack.

What was the patient's occupation and did his work know about his current health situation?

The patient is currently working and his workplace is aware of his health situation, offering him time off as needed.