Simulated Patient Brief — MIN (Chronic Heart Failure)
Location: General Practice. History only — no examination. Answer in the negative to any specific question not covered below.
- Name
- Min
- Age
- 66 years
- Opening statement
- “I’m worried about the swelling in my ankles and how breathless I’ve become.”
You have had heart failure for several years. Swollen ankles started four weeks ago and prompted this appointment. You are increasingly short of breath walking to the local park with your friend and sometimes need to stop at a bench. You already had some exertional breathlessness from longstanding heart failure, but this is much worse.
You are short of breath lying down, which makes it harder to fall asleep. There have been several recent nights when you have woken suddenly and needed to sit upright until breathing settles. Poor sleep is causing daytime fatigue and anxiety. No fevers or recent infections. Cough for about two weeks.
You can converse in full sentences but appear somewhat anxious.
Response to questions
- Open questions: describe ankle swelling, worsening SOB, sleep disruption as above.
- If asked specifically: now using three pillows. Cough is productive of clear, frothy sputum — no blood or coloured sputum.
Ideas: Unsure what is making you worse. Wonder if infection, or if the heart is getting worse. If asked about longstanding HF, you don’t feel much can be done long-term — “the damage is done.” Little point in lifestyle advice or medication changes.
Concerns: Impact of poor sleep and daytime fatigue; cough that will not go; SOB interfering with activities. Worried that if this is the heart it will never get better.
Expectations: Work out what is wrong and give you something to treat it.
- Hypertension for over fifteen years
- Heart attack nine years ago — hospitalised two weeks
- Heart failure diagnosed five years ago; last saw cardiologist six months ago — told it was well controlled
- Allergy to penicillin
- Ramipril 5 mg once daily, bisoprolol 2.5 mg once daily, furosemide 20 mg once daily
- If asked about compliance: you don’t take these diligently — “little point putting a patch over the cracks”
- Mother died of dementia in her 90s
- Father died of a “heart condition” in his 80s — details unclear
- No siblings
Never smoked. Glass of wine most evenings. Live in a bungalow with your supportive husband. Usually independent with shopping, cooking and cleaning.
Systems review: reply in the negative to any other symptoms.