GP CCE Cases · cardiovascular-health
First-episode exertional chest pain — CCE clinical encounter
CCE-style clinical encounter: a 49-year-old smoker with a first episode of exertional retrosternal tightness, normal examination and ECG, who wants reassurance and no tests. The candidate must apply the Marburg Heart Score, arrange CTCA-first pathway per NICE CG95, deliver smoking cessation, and document safety-netting.
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RACGP CCEFRACGP oralsCFPC SOOs
Prompt
A 49-year-old warehouse worker attends after a two-minute episode of central chest tightness while carrying stock upstairs last week; it eased with rest. He smokes 15 daily. His father died at 63 of 'a heart attack'. He wants 'the all-clear so my boss stops worrying'. ECG in the surgery is normal. Examination: BP 138/86, no murmurs, chest clear, no chest wall tenderness.
Objectives
- Take a discriminating history and calculate the Marburg Heart Score explicitly. [4]
- Explain the normal ECG honestly — what it does and does not exclude. [4]
- Arrange the CTCA-first pathway per NICE CG95 and deliver smoking cessation as parallel treatment. [6] [7]
- Safety-net with named red flags and a booked review. [12]
- Document the consultation to a defensible standard. [12]
References5ShowHide
- [4]Haasenritter J, Donner-Banzhoff N, Bösner S Chest pain for coronary heart disease in general practice: clinical judgement and a clinical decision rule. Br J Gen Pract, 2015.PMID 26500322
- [6]Timmis A, Roobottom CA National Institute for Health and Care Excellence updates the stable chest pain guideline with radical changes to the diagnostic paradigm. Heart, 2017.PMID 28446550
- [7]Kelion AD, Nicol ED The rationale for the primacy of coronary CT angiography in the National Institute for Health and Care Excellence (NICE) guideline (CG95) for the investigation of chest pain of recent onset. J Cardiovasc Comput Tomogr, 2018.PMID 30269897
- [10]Singh T, Bing R, Dweck MR, van Beek EJR, Mills NL, et al. Exercise Electrocardiography and Computed Tomography Coronary Angiography for Patients With Suspected Stable Angina Pectoris: A Post Hoc Analysis of the Randomized SCOT-HEART Trial. JAMA Cardiol, 2020.PMID 32492104
- [12]van den Bulk S, Petrus AHJ, Willemsen RTA, Boogers MJ, Meeder JG, et al. Ruling out acute coronary syndrome in primary care with a clinical decision rule and a capillary, high-sensitive troponin I point of care test: study protocol of a diagnostic RCT in the Netherlands (POB HELP). BMJ Open, 2023.PMID 37290947