GP Resources - HeFSSA Practitioners Program 2014 - Case 3

An elderly woman presents with chest pain intermittently over days, associated with SOB and fatigue and 1 episode of syncope. She has been hypertensive in the past and has refused to take statins for her Hypercholesterolemia because she says she is too old. She presents to casualty at 00H30 on a Sunday evening after returning from Australia on the Saturday. This case is to illustrate the wide differential associated with a diagnosis of AHF - and is to illustrate that the question must be asked about if this is not AHF, what else could it be- eg Pulmonary Embolus, Pneumonia etc. It also highlights the cardiac differential diagnoses including ACS, tight aortic stenosis, bilateral renal artery stenoses etc. the timing of her casualty visit is important as often these patients present when the least experienced doctors are on duty and the challenge of diagnosing the condition is significant. The role of statins in the elderly can also be discussed. This is a case of ACS related to severe CAD, but the differential should be discussed , as well as the management of ACS and AHF.