Cardiology · Model history
Chest pain: a focused urgent history
- Setting
- Emergency department
- Patient
- Mr. Johnson, 58, has had central chest pain for two hours.
- Listen
- 3 min
After listening
Say the next question
Read the patient’s answer, say your next question aloud, then reveal the model.
“Actually, twice in the past two weeks I felt a milder pressure walking uphill. It stopped when I rested, so I ignored it.”
Ask one focused question that would refine this patient’s cardiovascular risk.
Do you have high blood pressure, diabetes, or high cholesterol?
Model interview
Full transcript
- Doctor
Mr. Johnson, I'm Dr. Lee. I can see you're in pain. We're going to assess you right away. While the nurse connects the monitor and gets an ECG, tell me what happened.
- Patient
I've had this pain in the middle of my chest for about two hours. I thought it was heartburn, but it isn't going away.
- Doctor
What were you doing when it started?
- Patient
I was sitting at the kitchen table. It came on while I was resting.
- Doctor
Can you point to where you feel it? Does it spread anywhere else?
- Patient
It's right behind my breastbone, and it goes down my left arm.
- Doctor
How would you describe it in your own words?
- Patient
It's a heavy pressure, almost like something is sitting on my chest.
- Doctor
On a scale from zero to ten, how strong is it now? Has it been there continuously?
- Patient
About seven out of ten. Yes, it has been constant.
- Doctor
Have you felt short of breath, sweaty, nauseated, or lightheaded with it?
- Patient
I've been clammy and a little short of breath. I haven't vomited or passed out.
- Doctor
Does taking a deep breath, moving, or pressing on your chest change the pain?
- Patient
No. Nothing seems to change it. I tried antacids, but they did nothing.
- Doctor
Did the pain tear through to your back, or did you suddenly feel faint when it began?
- Patient
No, nothing like that.
- Doctor
Have you had anything similar before, even if it went away?
- Patient
Actually, twice in the past two weeks I felt a milder pressure walking uphill. It stopped when I rested, so I ignored it.
- Doctor
Do you have high blood pressure, diabetes, or high cholesterol?
- Patient
I have high blood pressure and type 2 diabetes. I'm not sure about my cholesterol.
- Doctor
Do you smoke? And has anyone in your close family had heart disease?
- Patient
I smoke about a pack a day and have for twenty years. My father died of a heart attack at sixty-two.
- Doctor
What medicines do you take, and have you ever had a serious reaction to aspirin or any other medicine?
- Patient
Metformin and lisinopril. I don't have any medicine allergies that I know of.
- Doctor
What is worrying you most right now?
- Patient
I'm scared this is a heart attack, like my dad had.
- Doctor
I understand. You have had two hours of constant central pressure at rest, spreading to your left arm, with sweating and shortness of breath. You also had two recent episodes with exertion and have several heart risk factors. Have I understood that correctly?
- Patient
Yes, that's right.
Flow at a glance
The route through the history
- Stabilize while talking
- Pin down onset
- Map pain and associated symptoms
- Check immediate alternatives
- Find prior episodes and risk factors
- Summarize without delaying care
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Editorial record
Tied to one reviewed case
This model uses a fictional Bedside English case as its source. The page and pre-generated WAV audio are checked against the same transcript and source-case fingerprints.
Editorial update: