My new patient comes in and shakes my hand. His chief complaint is a lung problem.

"I get short of breath when I try to do things. I can't exercise as much."

"How long?" I say, typing as he talks.

"Three months. It's been getting worse."

"Are you coughing? Were you sick? History of asthma? History of pneumonia?"

No. No. No. No. "No, I never smoked. No asbestos exposure. No chemical exposure. No family history of lung problems."

Past medical history, allergies, medicines, family history, surgeries...

Review of systems: "When you get short of breath, do you have chest pain?"

"No. Just this pressure. It feels heavy."

"Break into a sweat? Nausea? Does it stop when you stop the exertion?"

"A little sweat. Yes, maybe some nausea with it lately. Yes, it goes away after a bit."

"Pain up your neck or down either of your arms?"


"I think I should call a specialist." My patient is looking slightly confused.

I do not call pulmonary. I get the cardiologist on call. Relay the story fast. My patient is 56.

"Send him down. We can see him in two days. No treadmill, straight to cardiac catheterization."

"Aspirin and beta blocker?" I ask.

"Yep, get him started." says the cardiologist. "And a statin."

"Many thanks." I say. To my patient: "I don't think it's your lungs. I think it's your heart. And heart pain in men is usually pressure or weight, not sharp pain." I go over the medicines, side effects, give him nitroglycerin tablets, explain how to use them.

"One every five minutes up to three to get the chest pressure and shortness of breath to stop. If you take three you are to call an ambulance. Do not drive yourself: if you have a heart attack on the road, you could kill yourself and others."

He is still looking shocked, but he follows the instructions.


The catheterization showed blocked coronary arteries. He has a quadruple bypass. He has finished cardiac rehabilitation and has lost weight and takes his medicine.

I can't always tell what the chief complaint is going to bring in the room. But every so often the person gives a story that is practically right out of the textbook.....

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