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Chest Pain and Dyspnea Case Study
Diagnostic Reasoning in Primary Care
Case Scenario
Ms. L.T. is a 61-year-old female presenting with intermittent chest tightness and exertional dyspnea for 3 weeks.
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History:
- PMH: Hypertension, tobacco use (30 pack-years), anxiety
- Medications: Amlodipine 5 mg daily
- Symptoms: Chest discomfort radiating to jaw, relieved by rest
Vitals:
- BP: 156/88 mmHg
- HR: 96 bpm
Initial Findings:
- EKG: Nonspecific ST-T changes
- SpO₂: 95% on room air
Chest Pain and Dyspnea Case Study
Student Assignment Requirements
- Pathophysiology (25%)
- Compare and contrast ischemic vs non-ischemic chest pain mechanisms
- Explain cardiopulmonary causes of dyspnea
- Address anxiety overlap
- Assessment & Differential Diagnosis (35%)
- Focused cardiac and pulmonary exam
- Prioritized differential diagnosis
- Identification of life-threatening conditions
- Decision-making for ED referral vs outpatient management
Chest Pain and Dyspnea Case Study
- Pharmacology & Initial Management (30%)
- Acute and chronic pharmacologic considerations
- Antihypertensive optimization
- Risk reduction strategies
- Follow-up testing and referrals
Diagnostic Reasoning in Primary Care
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Case Scenario
Ms. L.T. is a 61-year-old female presenting with intermittent chest tightness and exertional dyspnea for 3 weeks.
History:
- PMH: Hypertension, tobacco use (30 pack-years), anxiety
- Medications: Amlodipine 5 mg daily
- Symptoms: Chest discomfort radiating to jaw, relieved by rest
Chest Pain and Dyspnea Case Study
Student Assignment Requirements
- Pathophysiology (25%)
- Compare and contrast ischemic vs non-ischemic chest pain mechanisms
- Explain cardiopulmonary causes of dyspnea
- Address anxiety overlap
- Assessment & Differential Diagnosis (35%)
- Focused cardiac and pulmonary exam
- Prioritized differential diagnosis
- Identification of life-threatening conditions
- Decision-making for ED referral vs outpatient management
- Pharmacology & Initial Management (30%)
- Acute and chronic pharmacologic considerations
- Antihypertensive optimization
- Risk reduction strategies
- Follow-up testing and referrals
Chest Pain and Dyspnea Case Study
Diagnostic Reasoning in Primary Care
Case Scenario
Ms. L.T. is a 61-year-old female presenting with intermittent chest tightness and exertional dyspnea for 3 weeks.
History:
- PMH: Hypertension, tobacco use (30 pack-years), anxiety
- Medications: Amlodipine 5 mg daily
- Symptoms: Chest discomfort radiating to jaw, relieved by rest