Download I-Human Case Study A 69-Year-Old Female Patient Named Mei Yang, Who Is Presenting With Che and more Exams Nursing in PDF only on Docsity!
iHuman Case Study: Comprehensive Analysis of a 69-
Year-Old Male with Chest Pain (Class 6531) in
Outpatient Clinic with X-Ray, ECG, and Laboratory
Capabilities (Latest November Version 2024)
Key details from the image:
Patient Name: Mei Yang Age: 69 years old Height/Weight: 5'3" (160 cm), 167 lbs (75.9 kg) Reason for Encounter: Chest pain Location: Outpatient clinic with diagnostic capabilities (radiology, ECG, labs)
This seems to be educational material for nursing or medical students using i-Human for diagnostic case simulations. If you need help analyzing this case or answering questions related
to it (e.g., differential diagnoses, next steps in management, interpreting test results), feel free to ask!
HPI – Mei Yang
Mei Yang is a 69-year-old female who presents to the outpatient clinic with a chief complaint of chest pain that began two days ago. She describes the pain as a pressure-like sensation in the center of her chest , which she rates as 6/10 in intensity. The pain is non-radiating and is associated with mild shortness of breath and fatigue. It is worse with exertion , such as walking up stairs, and improves with rest. She denies any recent trauma or injury to the chest.
She reports a similar episode about six months ago but did not seek medical attention at that time. She denies fever, chills, cough, or palpitations. No nausea or vomiting, but she admits to occasional heartburn , especially after meals.
She has a history of hypertension and hyperlipidemia , for which she takes lisinopril and atorvastatin. She does not currently take aspirin or any anticoagulants. She has never smoked, drinks alcohol occasionally, and denies recreational drug use.
She has no known drug allergies.
Expected Components of History in Chest Pain Case:
Here’s what you can typically expect in the history portion of such a case:
Chief Complaint (CC):
"Chest pain"
History of Present Illness (HPI):
Questions typically covered in HPI:
Onset: When did the pain start?
Smoking (past/present)? Alcohol use Drug use (e.g., cocaine?) Activity level Diet
Review of Systems (ROS):
Cardiovascular: Palpitations, orthopnea, PND Respiratory: Cough, SOB GI: Nausea, vomiting, indigestion MSK: Chest wall tenderness Neuro: Dizziness, syncope
Diagnostic Tests – Chest Pain Workup
🠀 1. Electrocardiogram (ECG) – STAT
Purpose: Evaluate for ischemia, infarction, arrhythmias Expected in Stable Angina: May be normal or show non-specific ST-T wave changes at rest If acute: Look for ST depression, T wave inversion, or ST elevation (STEMI)
🠀 2. Cardiac Biomarkers (Troponin I or T)
Purpose: Rule out myocardial infarction (MI) Draw baseline and repeat in 3–6 hours if concern persists Expected in Stable Angina: Normal If elevated: Suggests NSTEMI or myocardial injury
📷 3. Chest X-ray (CXR)
Purpose: Rule out pulmonary causes of chest pain (e.g., pneumonia, pneumothorax, aortic aneurysm) Expected findings: Normal in angina; may show other causes
🏃 ♀🠀 4. Stress Testing (after initial workup)
If ECG and troponins are normal but angina is suspected:
Options:
Exercise Stress Test (treadmill) Monitors ECG during physical exertion Stress Echo or Nuclear Stress Test Used if baseline ECG is abnormal or patient cannot exercise
🠀 5. Basic Laboratory Workup
To assess cardiovascular risk and comorbidities:
Lipid Panel: Hyperlipidemia confirmation HbA1c / Fasting Glucose: Rule out or monitor diabetes CBC: Rule out anemia (can worsen angina) BMP/CMP: Electrolyte and renal function (important before contrast use or medications)
🠀 6. Coronary CT Angiography (Optional)
For intermediate-risk patients if diagnosis remains unclear Non-invasive evaluation of coronary arteries
🠀 Summary:
Test Purpose Urgency
ECG Rule out ischemia/arrhythmia Immediate
Troponins Rule out MI Immediate + repeat
CXR Rule out pulmonary/aortic causes Immediate
Stress Test Evaluate inducible ischemia Next step after stabilization
Labs (Lipids, HbA1c, CBC) Assess risk & rule out contributors Routine
Vital Signs:
BP: 148/86 mmHg HR: 84 bpm RR: 18 Temp: 98.4°F SpO₂: 97% on room air BMI: 29.4 (Overweight)
Physical Exam:
System Findings
General Alert, NAD
Cardiac RRR, normal S1/S2, no murmur/rub/gallop
Respiratory Lungs clear bilaterally, no wheezes/rales
Chest wall No reproducible tenderness
GI Abdomen soft, non-tender
Extremities No edema, pulses 2+
Neuro AOx3, no focal deficits
Diagnostics (assumed or pending):
ECG: Normal sinus rhythm, no ST/T abnormalities Troponins: Negative CXR: Normal Labs: Lipids elevated, normal glucose, CBC WNL
A – Assessment
Primary Diagnosis:
Stable Angina Pectoris (Chronic Coronary Syndrome)
Rationale: Exertional, pressure-like chest pain relieved by rest in a patient with multiple cardiovascular risk factors and no acute ECG/troponin findings.
Differential Diagnoses:
- GERD – less likely due to exertional nature
- Musculoskeletal pain – no tenderness or positional component
- Unstable angina – less likely without worsening/rest pain and negative biomarkers
P – Plan
Diagnostics:
Continue ECG monitoring Serial troponins if chest pain recurs Schedule outpatient stress test (exercise or nuclear)
Medications:
Start low-dose aspirin 81 mg daily Continue atorvastatin Add short-acting nitroglycerin PRN chest pain Consider beta-blocker (e.g., metoprolol) for angina control Monitor BP, continue lisinopril
Lifestyle Modifications:
Low-sodium, heart-healthy diet Weight loss and gradual physical activity Smoking cessation reinforcement (if applicable)
Referrals:
Cardiology for further evaluation and stress testing Nutritionist for diet counseling
Patient Education:
Educated on signs of worsening angina, when to go to ER (e.g., unrelieved chest pain
10 mins, SOB, syncope) Encouraged adherence to medications and follow-up
Follow-up:
Return in 1 week or sooner if symptoms worsen Cardiologist referral within 1–2 weeks
✅ Final Diagnosis:
Stable Angina Pectoris (Chronic Coronary Syndrome)
✅ Rationale:
o Aspirin or clopidogrel
o Beta-blocker (e.g., metoprolol)
o Statin (already on atorvastatin)
o Sublingual nitroglycerin PRN
o ACE inhibitor or ARB (already on lisinopril)
Cardiology referral for further risk stratification and possible stress imaging or coronary angiography
✅ Differential Diagnosis – Chest Pain (Mei Yang)
1. Stable Angina Pectoris ✅ – Most Likely
Cause: Myocardial ischemia due to coronary artery disease (CAD)
Why it fits:
o Exertional chest pressure
o Relieved by rest
o History of hypertension and hyperlipidemia
o Overweight and older age
Next step: ECG, troponins, and possibly a stress test
2. Gastroesophageal Reflux Disease (GERD)
Cause: Acid reflux irritating the esophagus
Why considered:
o Episodic chest discomfort
o May coexist with angina
Why less likely:
o No food triggers reported
o Pain is exertional rather than post-prandial
o No burning sensation described
3. Musculoskeletal Chest Pain (e.g., Costochondritis)
Cause: Inflammation of costosternal joints or chest wall muscles
Why considered:
o Common in older adults
o Can mimic angina
Why less likely:
o No reproducible tenderness on palpation
o Not linked to movement or position
4. Unstable Angina / NSTEMI 🠀
Cause: Acute coronary syndrome (ACS) due to partial coronary artery blockage
Why considered:
o Elderly patient with risk factors
o Symptoms suggest ischemia
Next step: Must rule out with ECG and troponins
5. Pulmonary Embolism (PE)
Cause: Blood clot in the pulmonary arteries
Why considered:
o Can cause chest pain and dyspnea
Why less likely:
o No tachycardia, hypoxia, or acute distress
o No recent surgery, immobility, or DVT signs
Diagnosis Likelihood Key Distinguishing Features
Pericarditis Low Pleuritic, positional pain
