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Seb Aishous is a 55 year old gentleman who has presented to the outpatient cardiology clinic after a hospital admission five weeks ago.

Patient medications:  Bisoprolol 5mg  Aspirin 75mg  Atorvastatin 10mg  Lisinopril 10 mg  Metformin 500mg

Please take a history from Seb, focusing on his history of presenting complaint at his last admission. You will then be asked to examine the patient and discuss their case.

You are Seb, a 55-year-old chap who was admitted to hospital six weeks ago with some chest pain.

HPC: You vividly recall the events which lead to your hospital admission. While having dinner with your wife and daughter, suddenly a horrible feeling overcame you. You can’t really explain it: it felt like the world was ending. You then suddenly experienced a large chest pain in the middle of your chest, which did not move anywhere. You felt like a truck had fallen onto your chest. You didn’t have any sweating or feel clammy at the time. The pain lasted till the ambulance arrived and gave you some medication (about 30 minutes). If you had to score it out of 10, it would definitely have been an 11!

ICE: You immediately thought you were having a heart attack. It was the scariest moment in your life and you were concerned that you may never have left the hospital like your dad did. When you came to clinic, you were expecting to figure out what you could do to prevent yourself from getting another heart attack.

PMH: You never visited your GP for any medical problems nor have you had any previous surgeries. You felt that going to the doctors was a sign of weakness – now you know better and would go even fore a broken toenail! Since your hospital admission, it was discovered that you had hypertension, high cholesterol and diabetes.

SH: You do not currently smoke or drink. You drank at least two bottles of vodka on the weekends and only two beers every night prior to your hospital admission. In addition, you smoked 20 cigarettes a day for forty years. You have tried most recreational drugs but stopped after your first child.

FH: Your father and younger brother died of a heart attack at 45 and your mother had a stroke at 60. You have two healthy kids in their twenties.

DH and allergies: You don’t have any allergies. You don’t remember the names of all your medication but four are for your heart and one is for your diabetes. You take all your medication as required. You work at an office.

SE: No other symptoms.

A cardiac examination would be appropriate. Allow the student time to summarise, give a differential and discuss management of a STEMI in the acute setting and chronic management. This is a common condition which a foundation doctor in which a student should be fluent.

Discussion points - What secondary prophylaxis would you use for someone who has had a myocardial infarction? - Are you aware of any complications post MI? - Can you discuss the pathophysiology of an MI? - Is Seb’s age typical of a person who has MI? - Is there anything further you might consider investigating him or his family for as a consequence of this?