FLORENCE BLACKMAN I HUMAN CASE STUDY
66YEARS OLD FEMALE DIAGONISED WITH
CHEST PAIN 2 DIFFERENT VERSION FROM
EXPERT
FEEDBACK LATEST REVIEWED 2024.
VERSION 1
Florence Blackman (66 y/o female) – Chest Pain
• CC: Intermittent squeezing chest pain
• MSAP: Exertional “squeezing” mid-chest pain radiating to left arm,
relieved by rest, worse with cold
• Associated dyspnea on exertion
• History: HLD, HTN, previous smoker, family hx of heart disease
• Stressful work
History Questions:
- How can I help you today?
- Any other symptoms we should discuss?
- Do you have any allergies?
- Are you taking any OTC or herbal medications?
- Any new or recent changes in medications?
- What does the pain / discomfort in your chest feel like? (squeezing,
pressure, crushing, burning, stabbing, aching, tingling, suffocating)
- How severe (scale 1-10) is the pain in your chest?
, - Does anything make the pain in your chest better or worse?
- What are the events surrounding the start of your chest pain?
- Is there a pattern to your chest pain?
- Have you had any trauma to your chest?
- Does the pain in your chest radiate someplace else? Where?
- Do you have unusual heartbeats (palpitations)?
- Does the pain get worse with breathing?
- Does your pain awaken you from your sleep?
- Is your pain affected by what, when, or how much you eat?
- Do you presently have heartburn, a food or acid taste in your mouth?
- Do you drink alcohol? If so, what do you drink and how many drinks per
day?
- Do you have any of the following problems: fatigue, difficulty sleeping,
unintentional weight loss or gain, fevers, night sweats?
- Do you experience: SOB, wheezing, difficulty catching breath, chronic
cough, sputum production?
- Does anything make your shortness of breath better or worse?
- How long does your SOB last?
- Do you have any of the following: heat or cold intolerance, increased
thirst, increased sweating, frequent urination, change in appetite?
- Do you have any of the following: dizziness, fainting, spinning room,
seizures, weakness, numbness, tingling, tremor?
- Do you have problems with: N/V, constipation, diarrhea, coffee grounds
in your vomit, dark tarry stool, bright red blood in your BM, early satiety,
bloating?
- How is your overall health?
- Tell me about your work.
- Tell me about daily exercise or sports that you play.
Physical Exam:
- Vitals: pulse, BP, respirations
1
, - Examine skin
- Neck: measure JVP (jugular venous pressure) - Neck: auscultate carotid
arteries - Chest wall & lungs:
o Visual inspection of anterior &
posterior chest o Palpate anterior & posterior
chest o Auscultate lungs - Heart:
o Palpate for PMI (Point of Maximal
Impact) o Auscultate heart - Abdomen:
o Auscultate abdominal/femoral
arteries o Palpate abdomen
- Extremities: Visual inspection of extremities
Assessment note:
- F.B. is a 66 y/o Caucasian female presenting with 2-week h/o new onset,
intermittent, stable chest pain which radiates to the L arm, occurs with
SOB, is worse with cold temperatures and exertion, and improved by
rest. On physical exam she is pain free with stable vital signs. PMH risk
factors include: distant history of smoking (5 pack/years), a history of
HTN, and high cholesterol, and a family history of coronary vascular
disease.
- Stress test: 2-mm ST segment depression in inferior leads, 2, 3, and aVF
and V3-6 Diagnosis: Coronary artery disease: stable angina
Plan:
- Determine need for coronary angiography based on stress test results
and ECHO. Her Duke score of 10.5 is slightly above moderate risk, and
arguments could be made for both a trial at medication intervention
since the pt needs improvement on both HTN and
HLD o Augment management of preexisting HTN and HLD with a BB
(metoprolol 25 mg XR daily); a statin (atorvastatin 40 mg daily); and ASA
81 mg daily - Continue use of HCTZ 25 mg daily - Encourage lifestyle
modification:
2
66YEARS OLD FEMALE DIAGONISED WITH
CHEST PAIN 2 DIFFERENT VERSION FROM
EXPERT
FEEDBACK LATEST REVIEWED 2024.
VERSION 1
Florence Blackman (66 y/o female) – Chest Pain
• CC: Intermittent squeezing chest pain
• MSAP: Exertional “squeezing” mid-chest pain radiating to left arm,
relieved by rest, worse with cold
• Associated dyspnea on exertion
• History: HLD, HTN, previous smoker, family hx of heart disease
• Stressful work
History Questions:
- How can I help you today?
- Any other symptoms we should discuss?
- Do you have any allergies?
- Are you taking any OTC or herbal medications?
- Any new or recent changes in medications?
- What does the pain / discomfort in your chest feel like? (squeezing,
pressure, crushing, burning, stabbing, aching, tingling, suffocating)
- How severe (scale 1-10) is the pain in your chest?
, - Does anything make the pain in your chest better or worse?
- What are the events surrounding the start of your chest pain?
- Is there a pattern to your chest pain?
- Have you had any trauma to your chest?
- Does the pain in your chest radiate someplace else? Where?
- Do you have unusual heartbeats (palpitations)?
- Does the pain get worse with breathing?
- Does your pain awaken you from your sleep?
- Is your pain affected by what, when, or how much you eat?
- Do you presently have heartburn, a food or acid taste in your mouth?
- Do you drink alcohol? If so, what do you drink and how many drinks per
day?
- Do you have any of the following problems: fatigue, difficulty sleeping,
unintentional weight loss or gain, fevers, night sweats?
- Do you experience: SOB, wheezing, difficulty catching breath, chronic
cough, sputum production?
- Does anything make your shortness of breath better or worse?
- How long does your SOB last?
- Do you have any of the following: heat or cold intolerance, increased
thirst, increased sweating, frequent urination, change in appetite?
- Do you have any of the following: dizziness, fainting, spinning room,
seizures, weakness, numbness, tingling, tremor?
- Do you have problems with: N/V, constipation, diarrhea, coffee grounds
in your vomit, dark tarry stool, bright red blood in your BM, early satiety,
bloating?
- How is your overall health?
- Tell me about your work.
- Tell me about daily exercise or sports that you play.
Physical Exam:
- Vitals: pulse, BP, respirations
1
, - Examine skin
- Neck: measure JVP (jugular venous pressure) - Neck: auscultate carotid
arteries - Chest wall & lungs:
o Visual inspection of anterior &
posterior chest o Palpate anterior & posterior
chest o Auscultate lungs - Heart:
o Palpate for PMI (Point of Maximal
Impact) o Auscultate heart - Abdomen:
o Auscultate abdominal/femoral
arteries o Palpate abdomen
- Extremities: Visual inspection of extremities
Assessment note:
- F.B. is a 66 y/o Caucasian female presenting with 2-week h/o new onset,
intermittent, stable chest pain which radiates to the L arm, occurs with
SOB, is worse with cold temperatures and exertion, and improved by
rest. On physical exam she is pain free with stable vital signs. PMH risk
factors include: distant history of smoking (5 pack/years), a history of
HTN, and high cholesterol, and a family history of coronary vascular
disease.
- Stress test: 2-mm ST segment depression in inferior leads, 2, 3, and aVF
and V3-6 Diagnosis: Coronary artery disease: stable angina
Plan:
- Determine need for coronary angiography based on stress test results
and ECHO. Her Duke score of 10.5 is slightly above moderate risk, and
arguments could be made for both a trial at medication intervention
since the pt needs improvement on both HTN and
HLD o Augment management of preexisting HTN and HLD with a BB
(metoprolol 25 mg XR daily); a statin (atorvastatin 40 mg daily); and ASA
81 mg daily - Continue use of HCTZ 25 mg daily - Encourage lifestyle
modification:
2
