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[Music]
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hi my name's adam i'm a fifth year
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medical student can i check your name
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and date of birth harry miles 21 to the
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10th 1998. great and what's brought you
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in today i've just had this whole chest
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pain since last night
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um i didn't really think anything of it
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at the time and it just got
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worse and worse as
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the evening went on and then
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it was particularly bad
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in bed and couldn't get a wink of sleep
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all night okay can you tell me a bit
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more about it
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uh
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so it's it's
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sort of behind my breast bone slightly
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to the left
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um and again it sort of
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started to feel there but i didn't
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really think anything of it wasn't too
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bad and then it just got really really
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bad
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um you know as the evening went on i've
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just found that breathing became quite
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painful really i tried to take as
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sort of
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shallower breath as i could basically
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okay i'll just ask you a few more
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questions about that so you've told me
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the pain's in the middle did it come on
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suddenly or gradually
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uh
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i i guess it was suddenly but it was the
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pre the pain
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was
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gradually worse so it
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suddenly sort of i felt it but it wasn't
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too bad and then the pain got worse as
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it went on
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and how would you describe the pain
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it's sharp sharp sort of almost catches
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my breath quite a lot
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and you said it's it's in the middle of
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your chest slightly on the left side so
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does it go anywhere like to your left
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arm or to your jaw or does it just stay
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there no it stays there
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and when you get the pain
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do you get any other symptoms at the
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same time you like breathlessness
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palpitations do you feel sweaty
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no
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and when the pain comes on how long does
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it last for
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constant it's constant
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and it just gets worse and worse
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and you said it's worse when you're
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breathing is there anything else that
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makes it worse like if you're sitting in
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a certain position or if you're on
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exertion if you're walking around for
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example honestly walking around sitting
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down
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hurts just as much um i did find
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going to bed it started a bit more
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um but you know
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so was it worse when you were lying down
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yeah yeah
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yeah i think so
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and on a scale of one to ten how bad
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would you say the pain is if ten's the
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worst pain you can imagine and one's no
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pain at all
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it's pretty bad it's pretty bad i i
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don't like the
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number scale i just think one man's tens
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ten's another man's five you know i mean
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i understand what do you think could be
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causing you symptoms
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i've got a clue i'm not a clue
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are you worried about it
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uh
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i was kind of worried i was having a
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heart attack if i'm honest okay why is
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that
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uh
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three years ago my dad passed away from
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a heart attack um
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[Music]
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and so just
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kind of since then really have
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just been a bit more concerned about my
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heart you know i
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keep thinking about you know being in
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the hospital and things like that so
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i've tried to be a bit more sort of
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cautious
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i'm sorry to hear that it must have been
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really difficult
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was there anything you hoping i could do
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today
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if i'm honest i just want you to tell me
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i'm overreacting and
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sort me out okay and i'll just ask you a
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few more questions about your symptoms
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if that's okay
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have you felt unwell recently uh
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i had well i had the sniffles last week
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and a bit of a sore throat but uh you
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know i came through worse that now um
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well until last night basically
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any dizziness feeling faint or have you
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fainted no no nothing like that have you
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felt sweaty or had any night sweats
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no no
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any weight loss i wish
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any pain or swelling in your legs
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no
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have you had any trauma or injuries to
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your chest wall no
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i'm just going to summarise back what
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you've just told me if i get any of it
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wrong just let me know
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you've got a sharp central slightly
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left-sided chest pain which started last
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night after work
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it feels worse when you lie down and
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when you take a deep breath it's
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slightly better when you lean forwards
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you've had a sniffle and a sore throat
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recently does that sound about right
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yeah yeah and do you have any other
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medical conditions
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uh now i'm usually quite fit and well um
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i mean i i had uh my tonsils out when i
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was 12 but other than that you know
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quite an active lifestyle with my job so
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good
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do you take any regular medications
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uh
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no i i had my second cover job about six
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months ago though okay
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are you allergic to any medications or
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drugs that you know of ah not that i
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know of
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so you mentioned your dad had a heart
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attack how old was he when he had a
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heart attack
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uh he was
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about 68 years old i think
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okay
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and are there any other medical problems
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that run in the family nah
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i'm just going to ask you a few more
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questions about yourself if that's okay
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do you smoke
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socially um you know just sort of if i'm
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at the pub with my mates basically or
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just
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yeah
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socially have it then okay how many do
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you smoke and how often might you smoke
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uh
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maybe about once a week every other week
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maybe go through a couple maybe three
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okay
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and do you drink alcohol
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uh yeah so uh if there's like a good
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football game on well that's when we
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makes we go to the pub and that's when
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the cigarettes come out and have a few
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pints as well yeah okay so how many
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drinks might you have when you when you
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do drink uh not too many it's only about
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three or four i don't tend to drink much
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at home either um but yeah about
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probably three or four is that normal
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strength larger yeah yeah just sort of
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stuff off the tap okay how often do you
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go out with your mates for a drink
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uh
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maybe once a week every other week it's
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more just if there's a
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good game on you know just an excuse to
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see my mate basically
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do you take any recreational drugs or
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any any drugs that aren't prescribed
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from the gp uh
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about six months ago
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me and my mates went to a
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nightclub and we we had a bag of cocaine
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with us
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have you taken any recreational drugs
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since then no no no it was just a sort
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of one-off at the time okay do you live
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by yourself uh no i live with my fiance
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and uh my little dog
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and actually that reminds me um
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she also had the sniffles uh last week
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okay
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and have you traveled abroad anywhere
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recently
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uh well my my stag dude basically got
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cancelled because i coded so uh i've
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been anywhere in about three years now
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sorry to hear that
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are you working at the moment
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uh yeah i'm a plumber
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did you feel able to go to work with
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your symptoms um i i decided to have the
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day off today
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do you have any other questions
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that's the end of the consultation
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thanks for talking to me today
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harry is a 23 year old plumber who
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presented with a one-day history of
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sharp central chest pain the pain was
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worsened by lying down flat and
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alleviated by leaning forwards
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he's recently had symptoms consistent
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with a viral upper respiratory tract
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infection he denies any shortness of
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breath or syncope
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there's no significant past medical
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history and he doesn't take any regular
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medications he smokes two or three
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cigarettes a week and drinks three or
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four pints of normal strength lager
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every week he reports using cocaine six
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months ago
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but denies taking it since then harry's
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primary concern is a myocardial
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infarction
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as his dad had a heart attack aged 68
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and he'd like reassurance with regards
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to this
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based on the history today the most
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likely diagnosis is pericarditis other
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differential diagnoses include pulmonary
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embolism pleurisy and musculoskeletal
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chest pain
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to complete my assessment i'd perform a
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full cardio respiratory examination
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you
