SHORT · Heart Failure / CCF

Patient Details

Name: Sam Short
Age: 78 years
Opening statement: Progressive shortness of breath and reduced exercise tolerance — see clinical details

Facilitator Notes

Explore key history elements, semantic qualifiers, red flags
Discuss next steps and management plan with patient
Provide investigation results only if student requests them; debrief any missed tests
Students interpret results (can work with group), then discuss diagnosis and next steps

Resource: NICE CKS – Heart failure (chronic) — How to assess / Diagnosis.

Clinical Details – Part 1

Progressive shortness of breath over recent months; reduced ability to walk distances and play golf. No fever, no chest pain, no palpitations, no haemoptysis. Ankle swelling for last couple of months. Now sleeping with 3–4 pillows (flatter sleep less comfortable). Sometimes wakes at night feeling a bit breathless.

Patient Perspective (ICE)

Ideas: Becoming unfit or “it’s my age.”

Concerns: If it gets much worse, won’t be able to play golf at all. Also carer for partner with Alzheimer’s — worries about impact.

Expectations: Find out what is wrong and what can be done about it.

Past Medical History

High blood pressure 2004
High cholesterol 2004
Heart attack 2005
Heart bypass 2005
(Notes also: bowel cancer resected 2010)

Medication

Amlodipine 10 mg
Ramipril 2.5 mg
Atorvastatin 20 mg
Bisoprolol 2.5 mg

Family History

Dad died of heart attack in his 60s
Mum died of breast cancer in her 80s

Social History

Ex-smoker — 20 pack-years; gave up 20 years ago
Alcohol — none
Lives with partner who has Alzheimer’s; 1 grown-up child in Australia
Used to work as a carpenter

Demeanour

Chatty and open unless student uses closed questions, jargon, or rushes — then closes down to short answers.

End of consult 1: Expect discussion of what might be going on and next steps. Happy to accept management options — wants to understand and feel better to keep looking after partner.

Physical Examination (only if requested)

Alert and chatty; no obvious SOB at rest
Pulse 78 regular · RR 18 · Apyrexial · BP 140/78 · SpO₂ 95% RA
Chest: HS normal; coarse crepitations both bases; normal percussion

Information for the Student

Name: Sam Short · Age 78 · DOB 10 Sep 1945
PMH: Hypertension 2000 · Hypercholesterolaemia 2000 · MI 2008 · CABG 2005 · Bowel cancer resected 2010
Medication: Amlodipine 10 mg · Ramipril 2.5 mg · Atorvastatin 20 mg · Bisoprolol 2.5 mg
Recent: 3 months: X-ray confirms OA knee — physio initially, reluctant for surgery. 10 months: annual CHD review — no chest pain, tolerating meds, BP 135/80. 15 months: hearing aid referral

Part 2 – Second Consultation (Results)

Attending for test results. Likely to be told most likely heart failure. Shocked by the word “failure” — worries it means dying soon; worried about impact on partner. Keen on treatment for SOB and leg swelling (mobility). Asks about specialist referral and wait times:

~6 weeks — pleased
Quicker — surprised but very happy
Longer than 6 weeks — concerned about waiting and getting worse

Key investigation results (give only if requested)

NT-pro-BNP: 1340 (raised — thresholds: <75 yrs <125; ≥75 yrs <450)
U&E / eGFR: essentially normal (eGFR 86, creatinine 80)
Lipids: total cholesterol 7.4, LDL 6, HDL 1.1, trig 2.5 (uncontrolled)
Fasting glucose: 5.5
LFTs: largely normal

Primary Care Block · University of Buckingham