Physician's Assistant

Sdec Wed 23 July 2025 12:10

Last Modified: 257 days ago

MRN:

Content:

PTWR Dr Cristoni

Presenting Complaint:
Chest pain

Past Medical History
• Hypertension
• Asthma
• Husband recently had stroke and endarterectomy in France (contributing to patient stress)

Diagnosis:
Cardiac-sounding chest pain with uncontrolled hypertension
Isolated transaminitis of uncertain cause

I had the pleasure of meeting Mrs Armstrong in Same Day Emergency Care today.

Mrs Armstrong presented with chest pain that occurred at 21:00 last night. She described a crushing sensation, lasting 45 minutes, localised to the central chest without radiation to neck or arms. She has experienced similar but milder sensations occasionally over the past 2-3 years when lying down, but never with this severity. She denies any exertional chest pain, breathlessness (except when asthma symptomatic), or pain on deep inspiration.

She has a background of hypertension and asthma. She is currently taking Candesartan and Bendroflumethiazide for this. A statin was commenced in May 2022 as primary prevention. She denies alcohol consumption and takes no herbal remedies. There is significant recent stress due to her husband's stroke and endarterectomy in France.

On examination, she was comfortable at rest. Blood pressure was elevated at 196/93 mmHg in A&E, improving to 176/80 mmHg today. Chest examination was unremarkable with no focal tenderness. Abdominal examination was normal.

Bedside ultrasonography: Gallbladder polyps/adenomyatosis only. Hepatic steatosis. Duct normal for age. Echocardiogram reassuring

Plan:
1. Commence Amlodipine 5mg PO daily for additional blood pressure control - follow up with GP
2. CT coronary angiogram via rapid access chest pain clinic (requested and referred)
3. Urgent outpatient ultrasound abdomen (requested)
4. Safety netting provided regarding return if symptoms worsen or reoccur

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Summary:

Investigations:

Sdec Wed 23 July 2025 12:10

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