I-HUMAN PATIENTS CASE STUDY: ASSESSING THE CARDIOVASCULAR SYSTEM
, I-HUMAN PATIENTS CASE STUDY: ASSESSING THE CARDIOVASCULAR SYSTEM
Week 7 I-HUMAN PATIENTS CASE STUDY: ASSESSING THE
CARDIOVASCULAR SYSTEM
Case Title: "I Can't Catch My Breath Lying Down"
Patient: Robert "Rob" Coleman
Age: 72 years
Gender: Male
Race/Ethnicity: African American
Setting: Emergency Department (via ambulance)
Date of Encounter: April 6, 2026
1. Chief Complaint (Presenting Problem)
"I woke up last night completely unable to breathe. I felt like I was drowning. I had to sit up on
the edge of the bed for almost an hour before it got better. Tonight, I can't even lie down without
coughing and gasping."
Duration: Symptoms began 3 days ago with mild shortness of breath on exertion, acutely
worsened last night and again tonight. Presented to ED at 2:00 AM.
2. History of Presenting Illness (HPI) – Detailed
The student must elicit a thorough narrative, including onset, progression, precipitating factors,
and associated symptoms.
, I-HUMAN PATIENTS CASE STUDY: ASSESSING THE CARDIOVASCULAR SYSTEM
Onset and Progression
• 3 days ago: Noticed mild shortness of breath when walking from his car into the
grocery store. Previously able to walk 2 blocks without issue. Thought he was "just out
of shape."
• 2 days ago: Began sleeping on two pillows instead of one to breathe easier. Developed
a dry, non-productive cough at night.
• Last night (1 day ago): Woke at 1:00 AM with sudden onset of severe breathlessness,
gasping, and a feeling of suffocation. Sat upright on the edge of the bed for 45 minutes.
Symptoms gradually improved. Did not seek care.
• Tonight (presentation): Went to bed at 11:00 PM. Within 30 minutes, woke up with
same sensation but worse. Also noted pink, frothy sputum when coughing. His wife
called 911. Paramedics gave nitroglycerin 0.4 mg sublingual en route, which provided
partial relief. Arrives in ED at 2:15 AM.
Character of Breathing Difficulty
• "I can't get enough air in."
• "It feels like someone is sitting on my chest, but it's more of a suffocation than a pain."
• Denies chest pain – no pressure, tightness, or heaviness.
Clinical pearl: Acute decompensated heart failure often presents with dyspnea without
chest pain. However, ischemic heart disease is a common cause of HF, so student should
still inquire about angina.
Aggravating Factors
• Lying flat (supine): Symptoms worsen within 1–2 minutes.
• Exertion: Walking >50 feet or climbing stairs triggers dyspnea.
• Eating large meals: Postprandial dyspnea due to increased splanchnic blood flow and
diaphragmatic pressure.
Relieving Factors
• Sitting upright or standing: Relief within 5–10 minutes.
• Leaning forward (orthopnea): Patient sleeps in a recliner chair at home for the past 2
nights.
, I-HUMAN PATIENTS CASE STUDY: ASSESSING THE CARDIOVASCULAR SYSTEM
Week 7 I-HUMAN PATIENTS CASE STUDY: ASSESSING THE
CARDIOVASCULAR SYSTEM
Case Title: "I Can't Catch My Breath Lying Down"
Patient: Robert "Rob" Coleman
Age: 72 years
Gender: Male
Race/Ethnicity: African American
Setting: Emergency Department (via ambulance)
Date of Encounter: April 6, 2026
1. Chief Complaint (Presenting Problem)
"I woke up last night completely unable to breathe. I felt like I was drowning. I had to sit up on
the edge of the bed for almost an hour before it got better. Tonight, I can't even lie down without
coughing and gasping."
Duration: Symptoms began 3 days ago with mild shortness of breath on exertion, acutely
worsened last night and again tonight. Presented to ED at 2:00 AM.
2. History of Presenting Illness (HPI) – Detailed
The student must elicit a thorough narrative, including onset, progression, precipitating factors,
and associated symptoms.
, I-HUMAN PATIENTS CASE STUDY: ASSESSING THE CARDIOVASCULAR SYSTEM
Onset and Progression
• 3 days ago: Noticed mild shortness of breath when walking from his car into the
grocery store. Previously able to walk 2 blocks without issue. Thought he was "just out
of shape."
• 2 days ago: Began sleeping on two pillows instead of one to breathe easier. Developed
a dry, non-productive cough at night.
• Last night (1 day ago): Woke at 1:00 AM with sudden onset of severe breathlessness,
gasping, and a feeling of suffocation. Sat upright on the edge of the bed for 45 minutes.
Symptoms gradually improved. Did not seek care.
• Tonight (presentation): Went to bed at 11:00 PM. Within 30 minutes, woke up with
same sensation but worse. Also noted pink, frothy sputum when coughing. His wife
called 911. Paramedics gave nitroglycerin 0.4 mg sublingual en route, which provided
partial relief. Arrives in ED at 2:15 AM.
Character of Breathing Difficulty
• "I can't get enough air in."
• "It feels like someone is sitting on my chest, but it's more of a suffocation than a pain."
• Denies chest pain – no pressure, tightness, or heaviness.
Clinical pearl: Acute decompensated heart failure often presents with dyspnea without
chest pain. However, ischemic heart disease is a common cause of HF, so student should
still inquire about angina.
Aggravating Factors
• Lying flat (supine): Symptoms worsen within 1–2 minutes.
• Exertion: Walking >50 feet or climbing stairs triggers dyspnea.
• Eating large meals: Postprandial dyspnea due to increased splanchnic blood flow and
diaphragmatic pressure.
Relieving Factors
• Sitting upright or standing: Relief within 5–10 minutes.
• Leaning forward (orthopnea): Patient sleeps in a recliner chair at home for the past 2
nights.
