HSMC.Issues List - Gemini

1. Chest Pain - Current issues, reasons for visit, history of presenting complaints, including: onset, duration, progression, severity, associated symptoms, aggravating/relieving factors, impact on daily life, patient ideas/concerns/expectations: The patient, [insert age] Mr. John Smith, presents today with sudden onset of chest pain, described as a crushing sensation, which began approximately 2 hours ago while he was at work. The pain is located in the centre of his chest, radiating to his left arm. It is associated with shortness of breath and sweating. The pain is not relieved by rest and is worsened by exertion. He is very concerned about having a heart attack. - Past medical history, previous surgeries, current medications (including adherence, side effects), allergies relevant to this issue: Mr. Smith has a history of hypertension, well-controlled with medication. He takes Lisinopril 20mg daily. No known drug allergies. He had a previous appendectomy 10 years ago. - Likely diagnosis for Issue 1: Acute Myocardial Infarction (AMI). - Differential diagnosis for Issue 1: Angina, Aortic Dissection, Pulmonary Embolism, Musculoskeletal chest pain. 2. Hypertension - Current issues, reasons for visit, history of presenting complaints, including: onset, duration, progression, severity, associated symptoms, aggravating/relieving factors, impact on daily life, patient ideas/concerns/expectations: Patient reports his blood pressure has been slightly elevated at home readings over the past week, but he has been compliant with his medication. - Past medical history, previous surgeries, current medications (including adherence, side effects), allergies relevant to this issue: As above, taking Lisinopril 20mg daily. - Likely diagnosis for Issue 2: Controlled Hypertension. - Differential diagnosis for Issue 2: White coat hypertension, secondary hypertension. **Examination** - Objective findings: vital signs (BP, HR, RR, Temp, SpO2), general appearance, and system-specific examination findings (e.g., cardiovascular, respiratory, abdominal, neurological, musculoskeletal, mental state examination): BP 160/90 mmHg, HR 110 bpm, RR 24, Temp 37.1°C, SpO2 96% on room air. Patient appears anxious and in distress. Cardiovascular: S1 and S2 present, no murmurs, rubs, or gallops. Respiratory: Bilateral clear lung sounds. Abdomen: Soft, non-tender. Neurological: Alert and oriented. **Plan** - Investigations discussed or planned for all issues (e.g., blood tests, imaging, pathology): ECG performed in office (showing ST elevation in leads II, III, aVF). Bloods: Troponin, CBC, electrolytes. Chest X-ray. - Treatment planned for all issues (e.g., pharmacological, non-pharmacological, lifestyle advice, self-management): Aspirin 300mg stat. Oxygen via nasal cannula. Immediate transfer to the nearest hospital via ambulance for further management (percutaneous coronary intervention). - Relevant referrals discussed for all issues: Immediate referral to cardiology. - Overall follow-up plan and safety netting advice provided: Advised patient to call 999 immediately if chest pain recurs or worsens. Follow up with cardiologist.