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.

Bruce Adamski, 52 years old, non-Aboriginal or Torres Strait Islander.

Opening line: “I started to get chest pain while walking the dog this afternoon and it’s getting worse.”

You were walking the dog around the block when you started to get chest pain and feel quite lightheaded. You stopped and sat down on a bench, which usually helps if you get pain, however this time the pain didn’t resolve.

After about 10 minutes, you called your husband who picked you up, dropped the dog home and drove you to hospital.

The chest pain is currently central, feels like something is constantly ‘pressing down on your chest’. You’d rate the pain 8/10. There is no radiation. It started approximately 45 minutes ago, and gotten worse.

You feel lightheaded and weak, even simply lying down as you are.

You often feel a bit of chest pain and shortness of breath while walking but it usually resolves with a few minutes of resting.

You’ve been trying to walk more lately for your blood pressure and cholesterol. You haven’t got around to telling your GP about the chest pain yet as you’ve been busy taking on extra shifts at work.

If asked: no palpitations/feeling like your heart is racing. No cough, no difficulties sleeping at night, no weight loss.

Past medical history

You have a history of hypertension for which you take enalapril 20mg once daily and hydrochlorothiazide 12.5mg once daily. You’re taking atorvastatin 20mg daily for high cholesterol.

Your mother had type 2 diabetes managed with medications and passed away from a stroke at 72.

Your father is currently well. He had a stent placed in his heart during his 50s, thirty years ago, and he also has hypertension and high cholesterol.

No allergies.

Lifestyle and social history

You don’t take any recreational drugs or supplements. You drink approximately two glasses of wine per night.

You recently quit smoking, previously you smoked half a pack a day for the last 30 years.

You work as a train driver and your work can be stressful with long shifts.