Office of Education
Yale University
School of Medicine
367 Cedar Street
300 ESH
New Haven, CT
06519 USA

Name: Interview

Dr. Grey: Hi Todd. What brings you to see me?

Todd: I've been getting a pain in my chest when I run.

Dr. Grey: Go on.

Todd: It usually starts on Totoket hill.

Dr. Grey: Do you stop?

Todd: I do. I usually walk for about 3 minutes. Then it goes away and I start running again. If I run with Katherine, or my granddaughter Nel, I make up excuses, like "My foot hurts." I don't want them to worry. Especially Nel. She's the light of my life.

Dr. Grey: Where is the pain?

Todd: Right here, in the middle of my chest.

Dr. Grey: What does it feel like?

Todd: Pressure.

Dr. Grey: Do you feel dizzy or weak with it?

Todd: No.

Dr. Grey: Short of breath?

Todd: Maybe a little. It usually passes in a few minutes.

Dr. Grey: Any palpitations?

Todd: No.

Dr. Grey: Sweating?

Todd: I usually sweat when I run, but I have noticed heavy sweating with the pain.

Dr. Grey: Do you ever get pain when you aren't running?

Todd: Never.

Dr. Grey: It sounds like you are concerned.

Todd: I'll say! I wonder if my father's genes are catching up with me. I can't afford to lose that race.

Self-assessment question:

Which of the following is the approximate probability that Todd Hunter has obstructive coronary artery disease?

a. 50%
b. 60%
c. 70%
d. 80%
e. 90%

Large scale studies have shown that age, gender, and type of chest pain are the strongest predictors of coronary disease. The probability that a 64 year-old man with exertional chest pain has significant coronary artery disease is approximately 93% (reference 1). In Todd's case, the probability is so high that the purpose of further evaluation would be primarily to determine severity and guide treatment.

Next: Physical examination