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Comprehensive i-Human Case Study – Week 4, Class 6531: Expert Analysis of a 69-Year-Old Female with Exertional Chest Pain in an Outpatient Clinic Leading to a Diagnosis of Stable Angina Pectoris

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This detailed i-Human case study explores the clinical evaluation, differential diagnosis, and evidence-based management of a 69-year-old female presenting with exertional chest pain in an outpatient setting. Through simulated patient interaction, the case demonstrates a systematic approach to ruling out life-threatening conditions, utilizing diagnostic tools such as ECG, stress testing, and biomarker analysis, and ultimately diagnosing stable angina pectoris secondary to coronary artery disease. Key learning points include risk stratification, guideline-directed pharmacologic and lifestyle interventions, and the importance of patient education in chronic disease management. Ideal for medical students, educators, and clinicians seeking to reinforce clinical reasoning in cardiology.

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Comprehensive i-Human Case Study – Week 4, Class 6531: Expert Analysis of a 69-
Year-Old Female with Exertional Chest Pain in an Outpatient Clinic Leading to a
Diagnosis of Stable Angina Pectoris 2026-2027

,i-Human Case Study – Week 4, Class 6531: Expert Analysis of a 69-Year-Old

Female with Exertional Chest Pain in an Outpatient Clinic Leading to a

Diagnosis of Stable Angina PectorisPatient Demographics


Name: Mei Yang (Simulated i-Human Patient)


Age: 69 years


Sex: Female


Chief Complaint: Exertional chest pain


Setting: Outpatient Primary Care Clinic equipped with ECG, X-ray, and

laboratory capabilities


Occupation: Retired teacher


Social History Overview: Former smoker (20 pack-years; quit 10 years ago);

sedentary lifestyle; diet high in saturated fats; no alcohol or illicit drug use;

lives with spouse and is independent in activities of daily living (ADLs)


History of Present Illness (HPI)The patient is a 69-year-old female presenting

with intermittent exertional chest pain that began approximately 4 months

, ago. The pain is characterized as a pressure-like, squeezing sensation,

tightness, or heaviness, located substernally or mid-sternally. It is rated 6/10

in intensity at its worst and occasionally radiates to the left shoulder and jaw.

Episodes are triggered by physical exertion, such as brisk walking, walking

uphill, climbing stairs, or carrying groceries, and sometimes by stress. The

pain onset is gradual, lasts 5–10 minutes, and resolves with rest. It occurs a

few times per week and has remained stable in frequency and intensity.

Associated symptoms include mild shortness of breath (dyspnea) and mild

diaphoresis during episodes, but no nausea, vomiting, syncope, palpitations,

or pleuritic pain. There is no chest pain at rest, no recent trauma, respiratory

infection, fever, or gastrointestinal symptoms. The patient has not sought

prior medical care for this issue.Using the OPQRST framework:


Onset: Gradual, during exertion


Provocation/Palliation: Provoked by activity/stress; palliated by rest


Quality: Pressure, tightness, heaviness


Region/Radiation: Substernal; radiates to left shoulder/jaw

Document information

Uploaded on
December 29, 2025
Number of pages
22
Written in
2025/2026
Type
Case
Professor(s)
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Grade
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