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I-HUMAN CASE STUDY — WEEK 4 EXPERT
EVALUATION OF A 69-YEAR-OLD MALE
PRESENTING WITH CHEST PAIN (CLASS 6531)
— OUTPATIENT CLINIC SETTING
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1. General Case Information
Case title & summary:
69-year-old male with acute onset central chest pressure radiating to left arm and
diaphoresis. Case focuses on differentiating acute coronary syndrome (ACS) from
other cardiac and noncardiac causes, rapid risk stratification in the outpatient
clinic, initial stabilization, and disposition decisions — including when to transfer
to emergency care and activate reperfusion pathways.
Reason for encounter:
Acute chest pain that began while walking to the car 90 minutes prior to arrival;
patient walked into clinic seeking evaluation.
Patient demographics:
Age: 69 years
Sex: Male
Height: 175 cm (5′9″)
Weight: 88 kg (194 lb) — BMI ≈ 28.7 (overweight)
Case mode: Learning mode (Class 6531)
Case location: Outpatient primary care clinic with point-of-care glucose, BP cuff,
pulse oximeter, and ability to perform an immediate 12-lead ECG and basic labs
(POC troponin available). Clinic has protocols to activate EMS/transfer to nearest
ED/PCI center.
Attempts allowed: Unlimited
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2. Chief Complaint (CC)
Patient states: “I have a heavy pressure in the center of my chest that started
about an hour and a half ago.”
Onset: 90 minutes prior to arrival
Location: Substernal / central chest
Radiation: Left shoulder and ulnar aspect of left forearm; intermittent jaw
tightness
Character: Pressure/heaviness, oppressive (described as “a band around my
chest”)
Severity: 7/10 at worst; currently 5/10
Timing: Started while walking; persistent but waxing/waning
Associated symptoms: Diaphoresis, nausea, mild dyspnea, lightheadedness
for several minutes after onset
Relieving factors: Rest decreased severity but pain did not fully resolve
Aggravating factors: Exertion (walking), deep breaths do not markedly
change pain
3. History of Present Illness (HPI)
A 69-year-old man presents with acute central chest pressure that began ~90
minutes ago while walking to his car after a grocery run. He had to stop walking
because the pain increased; after 5–10 minutes of rest pain reduced but did not
fully resolve, so he went to the clinic.
Key points:
I-HUMAN CASE STUDY — WEEK 4 EXPERT
EVALUATION OF A 69-YEAR-OLD MALE
PRESENTING WITH CHEST PAIN (CLASS 6531)
— OUTPATIENT CLINIC SETTING
,2|Page
1. General Case Information
Case title & summary:
69-year-old male with acute onset central chest pressure radiating to left arm and
diaphoresis. Case focuses on differentiating acute coronary syndrome (ACS) from
other cardiac and noncardiac causes, rapid risk stratification in the outpatient
clinic, initial stabilization, and disposition decisions — including when to transfer
to emergency care and activate reperfusion pathways.
Reason for encounter:
Acute chest pain that began while walking to the car 90 minutes prior to arrival;
patient walked into clinic seeking evaluation.
Patient demographics:
Age: 69 years
Sex: Male
Height: 175 cm (5′9″)
Weight: 88 kg (194 lb) — BMI ≈ 28.7 (overweight)
Case mode: Learning mode (Class 6531)
Case location: Outpatient primary care clinic with point-of-care glucose, BP cuff,
pulse oximeter, and ability to perform an immediate 12-lead ECG and basic labs
(POC troponin available). Clinic has protocols to activate EMS/transfer to nearest
ED/PCI center.
Attempts allowed: Unlimited
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2. Chief Complaint (CC)
Patient states: “I have a heavy pressure in the center of my chest that started
about an hour and a half ago.”
Onset: 90 minutes prior to arrival
Location: Substernal / central chest
Radiation: Left shoulder and ulnar aspect of left forearm; intermittent jaw
tightness
Character: Pressure/heaviness, oppressive (described as “a band around my
chest”)
Severity: 7/10 at worst; currently 5/10
Timing: Started while walking; persistent but waxing/waning
Associated symptoms: Diaphoresis, nausea, mild dyspnea, lightheadedness
for several minutes after onset
Relieving factors: Rest decreased severity but pain did not fully resolve
Aggravating factors: Exertion (walking), deep breaths do not markedly
change pain
3. History of Present Illness (HPI)
A 69-year-old man presents with acute central chest pressure that began ~90
minutes ago while walking to his car after a grocery run. He had to stop walking
because the pain increased; after 5–10 minutes of rest pain reduced but did not
fully resolve, so he went to the clinic.
Key points:
