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. Author manuscript; available in PMC: 2010 Dec 1.
Published in final edited form as: Health Serv Res. 2009 Sep 23;44(6):1933–1949. doi: 10.1111/j.1475-6773.2009.01022.x

Table 1.

Symptoms embedded in the clinical scenario

Classic Symptoms and Signs of Coronary Heart Disease
  • Chest pain, described as:
    • worsening with exertion
    • after eating a big or spicy meal
    • when in a stressful situation
    • relieved by rest
    • feels different from heartburn
    • duration of about 3 months

  • Pain in the back between the shoulder blades

  • High blood pressure

  • “Levine fist” - clenched fist to the sternum, as a nonverbal indicator of cardiac pain

  • Stress

Additional Symptoms and Patient Complaints*

  • Gastrointestinal discomfort (e.g. feeling “full all the time,” “gassy”)

  • Heartburn

  • Indigestion not relieved with antacids

  • Spouse says patient is not acting like her/himself lately

  • Mood changes: easily irritated, concerned

  • Low energy level

*

Since patients seldom present as clear-cut textbook cases, additional symptoms and complaints that are not exclusively indicative of CHD were also presented. The purpose was not to make the physicians’ diagnostic task more difficult, but to increase the clinical authenticity of the scenario, so that it more accurately represented how actual patients present (DeVon et al. 2008; Dey et al. 2008; Milner et al. 1999).