“Not All Squeezes Are Cardiac” this scenario has been created as a CPD resource. read, digest then document the questions and place in your cpd portfolio 

Patient Overview:

Name: David Thompson
Age: 67
Location: 17 Old School Street Cardiff
Presenting Complaint: Sudden onset of throat tightness, sensation of constriction lasting ~15 minutes
History:

  • Barrett’s oesophagus, confirmed 18 months ago, under 2-year OGD surveillance

  • Awaiting elective quadruple CABG for triple vessel coronary artery disease

  • Longstanding GORD

  • Hypertension, hypercholesterolaemia, ex-smoker

  • Medications: Omeprazole 40mg OD, Bisoprolol, Atorvastatin, Ramipril, GTN spray

Initial Presentation (Prehospital / A&E):

  • Symptoms:

    • “Like a vice around my throat”

    • No chest pain

    • Slight dyspnoea and anxiety

    • No nausea, vomiting, radiation or syncope

  • Vitals on arrival:

    • HR 70 bpm

    • BP 128/82 mmHg

    • SpO2 96% RA

    • Temp 36.8°C

  • ECG: Normal sinus rhythm, no ischaemic changes

  • Troponins: Serial negative

  • Past OGD (6 months prior): Non-dysplastic Barrett’s oesophagus

Clinical Decisions Made:

  • Treated as suspected ACS given cardiac history — appropriately escalated

  • Full cardiac work-up performed (ECG, serial troponins)

  • Cardiology reviewed: symptoms deemed atypical, low likelihood of unstable angina

  • Consideration of gastro-oesophageal origin due to known BO

  • Gastroenterology consulted: likely oesophageal spasm or laryngopharyngeal reflux

  • PPI dose increased, lifestyle advice given, urgent follow-up arranged

  • Discharged with safety-netting and monitoring in place

Key Learning Points:

  1. Barrett’s oesophagus can present with upper chest/throat discomfort rather than classic heartburn.

  2. Oesophageal and cardiac symptoms often overlap, especially in older patients.

  3. High-risk cardiac patients must still be ruled out for ACS, even if symptoms are atypical.

  4. Reflux reaching the pharynx (LPR) can cause globus sensation, throat tightness, coughing, or hoarseness — and is often under-recognised.

  5. Paramedics and frontline clinicians should treat “throat tightness” with caution, particularly in cardiac patients.

Reflection Questions for CPD / Group Discussion:

  1. What features made this patient’s presentation suspicious for a cardiac event?

  2. Would you have treated this patient as a potential ACS in the prehospital setting? Why or why not?

  3. How confident are you in distinguishing cardiac chest pain from GI-related pain or discomfort?

  4. What red flags or safety-netting advice would you give to this patient on discharge?

  5. How can you apply this case to improve clinical decision-making when symptoms are atypical?