Chest Pain and Dyspnea: Diagnostic Reasoning in Primary Care

Ms. L.T. is a 61-year-old female presenting with intermittent chest tightness and exertional dyspnea for 3 weeks.

History:

· PMH: Hypertension, tobacco use (30 pack-years), anxiety

· Medications: Amlodipine 5 mg daily

· Symptoms: Chest discomfort radiating to jaw, relieved by rest

Vitals:

· BP: 156/88 mmHg

· HR: 96 bpm

Initial Findings:

· EKG: Nonspecific ST-T changes

· SpO₂: 95% on room air

Student Assignment Requirements

1. Pathophysiology (25%)

· Compare and contrast ischemic vs non-ischemic chest pain mechanisms

· Explain cardiopulmonary causes of dyspnea

· Address anxiety overlap

2. Assessment & Differential Diagnosis (35%)

· Focused cardiac and pulmonary exam

· Prioritized differential diagnosis

· Identification of life-threatening conditions

· Decision-making for ED referral vs outpatient management

3. Pharmacology & Initial Management (30%)

· Acute and chronic pharmacologic considerations

· Antihypertensive optimization

· Risk reduction strategies

· Follow-up testing and referrals

4. APA & Evidence Integration (10%)