i-Human Case Study: 69-Year-Old Male with Chest Pain – Week 4 (Class 6531) – Outpatient Clinic with X-Ray, ECG, and Lab Capabilities – Expert Evaluation

This i-Human case study (Week 4, Class 6531) involves a 69-year-old male presenting with intermittent chest pain over 3 days (pressure-like, substernal, radiating to left shoulder and jaw, 6/10 severity, lasting 5-10 minutes, occurring with exertion and relieved by rest). Associated symptoms include mild shortness of breath, diaphoresis during episodes, and fatigue. Risk factors include hypertension (20 years), type 2 diabetes (10 years), hyperlipidemia, former smoker (40 pack-years, quit 5 years ago), obesity (BMI 30.1), and strong family history of coronary artery disease (father died of MI at 62). Physical exam reveals BP 148-152/88, HR 84, clear lungs, no murmurs, no chest wall tenderness. ECG shows normal sinus rhythm with ST-segment depression in leads II, III, aVF, suggesting myocardial ischemia. Differential diagnoses include stable angina pectoris, acute coronary syndrome (unstable angina/NSTEMI), GERD, costochondritis, and pulmonary embolism. Management includes immediate aspirin 325 mg, oxygen if hypoxic, urgent ED transfer via EMS, cardiology consultation, and possible cardiac catheterization. Ideal for learning chest pain evaluation, acute coronary syndrome recognition, ECG interpretation, and emergent management in outpatient settings.