Hello welcome to power hello welcome to the medical registrars we're just going to go and see doctor stephanie 1 of our consultants who's just finding me 1 of these rooms how are you feeling very well I'm a good hip I feel recall no emotions emotions this is my husband who's just had a stroke recently oh I see and then a hysterectomy I believe yeah but last week oh goodness in france yes I heard about it in the past I'm only here looks like they did a good job yes I think they did good well actually you're travelling I'm glad I wish you were able to provide such a simple case really well surely british hospitals food can't be better than prep haven't been in the british we were just hearing about this gentleman's stroke in france has had an endarterectomy by the looks of it not from the stroke no in fact you were in peripheral vision alright and I still can't I think that's why my blood pressure has gone up so high yes probably because it's very stressful we'd have found that in a way to 24 hours at my own space again alright so is that you had a bit of problem no 09:00 last night 09:00 last night I stopped I went to bed about 10 and got off and not coming in you had this before only slightly on the odd occasion over about maybe 2 or 3 years I might go to bed and think oh I've got that sort of lump feeling but I've never had any other pain was with it more a sensation feeling the heartbeats or a feeling of a pain no just this sort of crushing like chronic indigestion sort of thing okay and you suffer from reflux of the bed no no so you never had this problem apart from some sensation when you were laying no mean you've never had the proper pain like this before no no okay and when you walk or walk down the stairs do you feel pain no never felt never felt breathless no sometimes if if my asthma's playing up I've got asthma asthma asthma yeah and sometimes I might wheeze but okay no pain going up from asthma do you have hypertension yes I can say yes actually take medication all day do you take medication yes do wanna see my list of prescriptions no it's fine it's fine I mean as long as the other the other thing do you have cholesterol high cholesterol or no diabetes no no perfect okay they gave me a statin to take just as a precautionary measure 5 5 5 can the start out there's no statin 20 yeah yeah symbicort probably the tibia vein submesional dendropenothiazide okay so the pain was here right there there mhmm and if I press do I cause this pain or no no the pain is not reversed blood pressure was yellow not any pain no look blood pressure was a 196 and a 93 in a and e bing left flat will be a pause for the pain the blood pressure blood pressure hundred and 96 and 80 176 today can you let me explore your tummy just a second that is certainly good should say hang on she lost tissue 1 moment please started already when did you start the taking the medication for the cholesterol may 2022 well I haven't got the statin yeah 2 and 3 years ago I should think not because I've cholesterol was so I just prevented it you don't have any pain here when you're breathing okay can you can you feel better mister jones for you let me just take this down just scan it a little yeah I'm just telling you because the only thing that we I've thought I've it saw is a bit of an inflammation of your liver that's not the thing have you had an ultrasound like this alright so she's got stool just a second yeah any pain here if I press no no okay that's good great take a deep breath again and hold your breath not crossing a shadow exactly it's it's there not severe think think about gallbladder there are no areas spare it does not explain the trabeculitis no no and then she doesn't have any pain so she's not done hypotensive liver injury is a possibility isn't it hypotensive not hypotensive have seen a long standing very severe hypertension I've seen only hypertensive patients the the the worst the chitorecauses are because of shock you know mhmm mhmm but never had a hypertension however no yeah I can't see any take a deep breath again no I don't think that there's anything here have you been drinking I don't drink you do drink I don't drink you don't drink you taken any herbal remedies nothing other than the doctor's medication okay so we will ask the gp to do some investigations on this nils uh-huh formal ultrasound we'll do an ultrasound okay just highlighting mhmm routine yeah take a deep breath again I don't think that you have there sometimes the liver can't contain chest pain but we don't think it's the case now can't be with drinking is that what I put in when I'm cooking some wine or brandy you can't get any liver disease and not in july maybe just the ctca as a clinical are we going to call it symptomatic hypertension yeah could be I mean she could have had this but this is ischemic pain if we think that this is the cause I think we can call it specific chest traction cardiac sound in chest pain non uncontrolled bp patient with uncontrolled bp under stress could be just stress but we want to have a look to your heart through our chest pain clinic that basically they do a ct scan and they check your coronaries you know the vessel of your heart and if they are okay then probably we can just label this pain as no specific none of those pain otherwise if they start seeing some plaques or or or strictures they may advise to do an angular a proper angular I'm careful with a little cannula here ct scan is just they give you a bit of a dial and then they take a picture that's it that each day no no no it's not gonna be today it'll be a follow-up yes it's gonna be not even tomorrow likely it will be likely to be in a week or 2 mhmm and the chest x-ray didn't show any anything see it come and have a look at it these were nice stuff tiny stuff miniature sticks 3 done today would you like it to roll just yeah yes alright good breathe again and hold the breath good okay yep and give you some tissue so we're seated on your angiogram they're on a quest a just the x-ray she's here oh okay just might spit a bit okay now right good that's clear good thank you and the pain you can't feel any pain anymore no pain on exertion usually just crushing chest pain last 15 minutes 45 minutes didn't go to your neck it stayed here it just made it right chest x-ray patient ct coronary angiogram request for ocular review that's not taken what happens now professional medications you are only taking candesartan you taking them yes took them this morning okay so probably we just add amlodipine the routine that you can start taking now 5 5 add another woman yeah yes amlodipine amlodipine it's another medication it yes yeah so take it 5 mg and then from and then tomorrow morning as well and then from the day after and then see actually take it every day in the morning okay until next week and then see your gp to check if you need to increase okay yes and now probably you're gonna be settled now because you see your husband that recovered from you yeah and they did a good job in france it's not my fault it's not my fault and he's on your washout oh so giving her too much stress can't drive so anyway I'm fine really I don't know I just wanna keep the blood pressure down the blood pressure yeah and it's already gone down quite a bit since I've been in here this morning and if it happens again you must come back yeah we'll do a blood pressure monitor and close to you twice a month last night was a 190 something I thought was mhmm so here's your if you have other these little chests being there yeah you just come back do we get a prescription from here yeah I'll write you a prescription for boots which is just at the montessori we were just hoping you might have a chest x-ray before before you go which I've requested do you a can try and send it to a boots somewhere in the community if you want we can go up there can't we yeah go up there it'll be easier quite a strong and I'll request it for you now have your chest x-ray yeah and then come back I'll make sure it's all fine and we'll go again alright that sound good yes love it chest x-ray next then chest x-ray next after you back in the waiting room when is every tissue exposed to the piafrin so you'll go to aed x-ray which is I'll show you the way so you go through this way you go right and it'll take you to the main corridor of the hospital go across the protocol and then you'll see the x-ray tomorrow no and then they will do your x-ray no that's all they're saying they know they I've requested it they'll know all about you you'll see your doctor at birth okay very much lovely and they come back I'll tell you the result then you can get out to your doctor thank you great I'll see you