D: Yeah, so you're a 26 year old, generally healthy and with, sorry back pain?

P: Chest pain. 

D: Chest pain, OK. When did the chest pain start?

P: Um so I, I guess I I don't know if I'd really call it pain, it's it's been just very uncomfortable, like it just felt a little odd for like a week and a half. It's kind of.

D: A week and a half? 

P: Yeah, it's kind of like a very sharp, strong pain uh when I take a deep breath.

D: OK. 

P: But I don't notice it all the time, it's just, it's often when um I'm sitting and studying or when I'm walking, when I'm walking to school.

D: OK, did you have any accidents or injuries around that time?

P: Uh no, nothing that I can think of.

D: OK, did it come on suddenly? Or is it more gradual?

P: Yeah, it's uh, no it's it's pretty, it's pretty well, it seems the same each time. It kind of lasts like 20 minutes or so, um and I've tried Tylenol and I've tried Advil um and I've even tried like a like an Alka-Seltzer and it hasn't really helped very much.

D: OK, so it's pretty, it's not consistent throughout the day, it only happens at certain times of the day?

P: Yeah, it'll come on for like 20 minutes like here and there.

D: OK, anything that you think triggers it?

P: I don't I don't really know. Uh I was kind of worried um, I was kind of worried that it could be a heart thing, I I feel like it might it might be, it could be stress uhm but I'm I'm not really sure, my dad had a heart attack last year, he was pretty young. He's like in his 50s and it it just kind of scares me because now he's having these heart problems.

D: OK, so these chest pains last for about 20 minutes, it only happens when you take a deep breath in, and after the 20 minutes, do they come and go? Is it something that gradually weans off, or is it fairly sharp?

P: It seems like it kind of goes away once I, once I'm at school and like talking to people and doing other things. It's kind of when I'm, I notice it when I'm on my walks when I'm alone or like when I'm studying alone more, like maybe I have it when I'm talking to other people, but I don't really notice it.

D: OK, does it get worse with exercise?

P: Uh I don't think so. It just kind of, like when I'm walking to school, it kind of stays the same. I haven't done any strenuous exercise lately, 'cause I've just had so much uh schoolwork piling up.

D: So you mainly get it at, so you can get it at rest, I should say.

P: Exactly, yeah, like when I'm studying.

D: OK, any fevers? Sick at all last little while?

P: Uh no, no, I don't think so.

D: No, you've been feeling well otherwise?

P: Yeah, I mean, besides just kind of feeling stressed, I uh like I I've been trying to quit smoking and that's been, that's been kind of hard, and school's just very, very busy right now.

D: When did you stop smoking?

P: Um so like I guess I'm trying to quit, I'm smoking less than I used to. I probably smoked 5 cigarettes a day, but it used to be a little bit more.

D: OK, coming back to the stress, is there anything recently that's causing you more worries?

P: Um it's just that I'm I'm doing my Masters of social work and I'm getting towards the end and it's just, it's very scary because I'm working on my final uh thesis and there's just a lot involved and it's it's just making me very nervous.

D: OK, is there anything special about the last couple of weeks that's made you more stressed than previously?

P: Uh I think just the the time crunch of having to to finish this. I've never felt like so, like there is so little time to do the work that I need to do.

D: Got it. Have you ever felt this pain before, anytime in your life?

P: No, no, not before this.

D: OK. So it comes on several times a day, not necessarily triggered by anything, and you said you smoke. When did you start smoking?

P: Um like when I was probably 18 I I sometimes smoked a little and then I smoked a little more, um maybe like 10 cigarettes a day for uh like the last two years. But then a few months ago I've been I've been cutting it in half. 

D: OK, now when you get this this chest pain, do you ever feel short of breath?

P: Um I I think I I make myself nervous with it and then I kind of start breathing faster, but I don't have a hard, I don't have a hard time breathing otherwise, and it's hard to get a deep breath 'cause I'm, it makes me really nervous.

D: Does your heart ever flutter? Feel like it's skipping a beat?

P: Uhm no, only if I, only if I, if I, if I'm having kind of an anxiety attack that's felt like that before, but not any other time

D: OK, don't get any chest pain, all right, and just in terms of other things, so anything else you've seen a doctor for in the past? You mentioned anxiety attacks.

P: Yeah, um like I talked to my family doctor about that when I was a teenager but I really haven't, you know, seen my doctor for it anytime in the last like eight years or so.

D: Anything else you see your family

P: I don't, oh, sorry, no nothing else. I just I thought I was kind of, when I was in high school I had those and then I really haven't for a long time. But um lately I felt like this like I could maybe get them again. 

D: So you've never had asthma as a child?

P: Uh no. 

D: And you don't have asthma now?

P: No.

D: OK, do you take any medications right now?

P: Uh no, like I take like a multi vitamin but that's it.

D: OK, and you live in London?

P: Mhmm, like for school.

D: Got it. You're doing a Masters in social work, anyone around you been sick at all last little while?

P: No, like I live alone, I haven't really seen very many people lately.

D: OK, and how do you manage stress when you do get it?

P: Um I try to I try to like set some time aside just to read books that like I like to read instead of like school books uh at night time, and uh I do really enjoy running, it's, I've been a little bit nervous to do it lately, but usually I run like a few times a week.

D: OK, and when you're pretty preoccupied, do you ever get the chest pain? 

P: Um like when I'm really, when I'm work, like working with classmates or uh like thinking really like if I'm talking to someone else, I don't really get it or if I if I'm like working on a task with my hands, but it's when I'm walking and I am alone kind of with my thoughts or when I'm studying, that's when I when I get it.

D: Understood and you said your father passed early from a heart attack, I'm sorry, but anyone else in your family either your parents or mum have any health issues? 

P: Oh he's uh he's alive, like he had a heart attack and just now he has to see a lot of heart doctors. Um no, there's nothing else in my family like that. I don't really know like about my grandpa, like my dad's dad, but like he might have also, um he just kind of, he just passed away young from um like an accident. So yeah, I'm not really sure.

D: Got it, so no one has died suddenly with no explanation when they were young or while they were swimming?

P: No.

D: No one's ever talked about arrhythmias, or is that a word familiar to you?

P: No, no, just my dad and his heart attack. That's like the only thing I know of.

D: OK, sounds good. I think I've got all the information I need and I'll pass it on to the doctor who'll take a look at you, OK? Have a good one.

P: OK, thank you.