Physician's Assistant

Patient Details

Sdec (281 days ago 09:19)

Sdec Sun 29 June 2025 09:19

Last Modified: 281 days ago

MRN:

Content:

Presenting Complaint:
Chest pain

Past Medical History
• Frequent ED attender
• Hypertension
• Type 2 diabetes (most recent HbA1c 50)
• Paracetamol overdose
• Multiple attendances with alleged assault
• Bipolar disorder
• Low vitamin D
• Long-standing anaemia

Diagnosis:
Atypical chest pain - non-cardiac
Longstanding anaemia and low platelets of uncertain cause - Possibly lithium related

I had the pleasure of meeting Mr James in Same Day Emergency Care today.

Mr James is a 61-year-old gentleman who presented with chest pain, having attended on 27th June with similar symptoms and again at 05:00 this morning. He describes the pain as sharp and crushing, located in the lower chest. The pain does not appear to be exertional and he denies any breathlessness on exertion. No leg swelling,  Of note, he has long-standing anaemia which has not yet been investigated, no haematemesis, melaena or visible haematuria, no weight loss.

Pain has now resolved and feeling much better - wants to go home.

On examination: no oedema, normal heart and breath sounds. Looks well

Investigations:
CRP: 1
Troponin: 3 (normal)
Haemoglobin: 126
Platelets: 106
Venous blood gas: Normal
ECG: SR nil ischaemic.

Plan:
1. USS Liver routine outpatient - Low platelets ? cirrhosis
2. Discharged home
3. HEART score 2 -> Primary care follow up
4. Add haematinics, if IDA consider further investigations

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Patient Details

Sdec Sun 29 June 2025 09:19

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