Facilitator notes

Facilitator, please role-play this patient and allow the student/team to collect a focused history. The key elements are reported here, provide generic information when there is no applicable answer below.
After the role-play, provide the History handout to the player.

Mike Simpson, 64 years old, non-Aboriginal or Torres Strait Islander.

Opening line: “My feet and legs have been swelling like sausages on-and-off for 3 months now and I don’t know what to do about it”.

You have noticed the swelling is worse in the morning. You have no pain in your legs and no recent lower limb trauma. They are not red, hot or itchy.

You have also noticed yourself becoming “less fit” and needing to catch your breath more often.

You are struggling to walk uphill on your daily walks and need to take frequent breaks. It has gotten particularly bad in the last month.

You have no cough, wheeze or chest pain. You haven’t noticed any light-headedness.

Your only past episode of shortness of breath was during your heart attack 2 years ago. It was associated with chest pain and only lasted a few hours until you sought treatment.

You are more tired than normal and have been for the last 6 months or so. You thought it might just be part of ageing.

Your sleep has been fine, but you are sleeping on more pillows than normal, because you get breathless lying down for long periods of time.

No recent weight loss. No change in appetite.

Past medical history

You had a myocardial infarction 2 years ago treated with a stent. You have also had hypertension for 10 years. You take aspirin, atenolol and ramipril daily and have GTN spray to use if you get chest pain, but you haven’t had to use it for a long time.

You used to also take a statin, but you stopped that as you didn’t like the idea of taking it. You saw a cardiologist about 6 weeks after your heart attack but never since. Your mother has diabetes and your father had a heart attack when he was 55.

Lifestyle and social history

You live with your wife, Susan. You have recently retired from working in a bank. You smoke 5 cigarettes a day (recently cut down from a pack a day). You started smoking 40 years ago. You drink 2-3 beers most nights. You go on a short walk in the morning on most days, unless it is raining. No recent travel.