01New symptom / safety review

Chest tightness on exertion before a same-day review.

A patient describes a symptom in ordinary language. Ella structures the onset and pattern while making unresolved safety questions visible to the reviewing clinician.

Patient: Patient A
Profile: 58 years / male
Pathway: Same-day clinic request
Illustrative length: 03:24

Consultation playback

The patient speaks. Ella follows what changes the history.

This anonymised demonstration shows the shape of a pre-appointment conversation. Each response remains in the source transcript for later review.

Ella consultation

Patient A / Voice capture

Live transcript

Ella
Tell me what has prompted you to seek an appointment today.
00:03Turn 1
Patient
I have a tight feeling in my chest when I walk upstairs. It started yesterday.
00:18Turn 2
Ella
Does it settle when you rest, and are you having it right now?
00:34Turn 3
Patient
It settles after I stop. I do not feel it while sitting here.
00:49Turn 4
Ella
Have you noticed breathlessness, sweating, nausea, or pain spreading to your arm or jaw?
01:04Turn 5
Patient
I felt slightly short of breath on the stairs, but no sweating or spreading pain.
01:26Turn 6
Ella
Has anything like this happened before, or is this the first time?
01:43Turn 7
Patient
This is the first time it has been this clear. I did feel a bit puffed doing the garden last week, but I put that down to being unfit.
02:01Turn 8
Ella
How much do you have to do before it comes on, for example how many stairs?
02:18Turn 9
Patient
About one flight. I have to stop halfway up and wait for it to ease before carrying on.
02:34Turn 10
Ella
Do you take any regular medication, smoke, or have heart problems in the family?
02:52Turn 11
Patient
I take tablets for blood pressure. I gave up smoking a few years ago, and my father had a heart attack in his sixties.
03:10Turn 12

Consultation captured12 turns

Post-call clinician review

The prepared note stays connected to what was said.

Representative prepared-note view based on Ella's current review structure. Ella prepares information for review. It does not diagnose, prescribe, or replace clinical judgement.

Clinician review / consultation note

Opening history

Patient A58 years / male12 turnsPrepared note

Summary

New exertional chest tightness beginning yesterday, occurring on climbing stairs and resolving after rest. The patient describes a consistent exertional threshold of roughly one flight of stairs, needing to stop and wait before continuing.

Patient reports mild exertional breathlessness, with a possible similar episode while gardening last week. No pain at rest, radiation, sweating or nausea reported in this conversation.

Background disclosed in conversation: treated hypertension, ex-smoker, and a first-degree family history of myocardial infarction. These cardiovascular risk factors are surfaced for the reviewing clinician alongside the symptom pattern.

History fields / source linked

Presenting concern

Exertional chest tightness

Turn 02

Onset

Since yesterday

Turn 02

Pattern

On stairs; resolves with rest

Turns 02-04

Exertional threshold

After about one flight of stairs

Turn 10

Associated symptom

Mild breathlessness on exertion

Turn 06

Prior episode

Possible breathlessness gardening last week

Turn 08

Cardiac risk factors

Treated hypertension, ex-smoker, family history

Turn 12

Triggered questionnaire

Exertional chest pain screen

Auto-triggered by chest tightness reported on exertion in a patient over 40.

Auto-triggered

Is the discomfort brought on by exertion?

Yes

Does it ease within a few minutes of rest?

Yes

Any pain radiating to the arm, neck or jaw?

Sweating, nausea or clamminess with episodes?

Any chest discomfort at rest or waking from sleep?

Known heart disease or previous cardiac investigation?

Not reported

Pattern is consistent with exertional, rest-relieved chest tightness. Forwarded for clinician review of cardiac risk; it is not scored or used as a diagnosis.

Inspect transcript source

Patient transcript

"I have a tight feeling in my chest when I walk upstairs. It started yesterday."

Onset

Since yesterday

Safety review

Pain at rest

Denied

Not present during the consultation; symptom reported as exertional only.

Radiation / autonomic symptoms

Denied

No radiation to arm or jaw, sweating or nausea reported.

Exertional breathlessness

Present

Mild breathlessness on stairs, with a possible earlier episode.

Cardiac risk factors

Present

Treated hypertension, ex-smoker and family history of MI reported.

Clinical urgency

To verify

Clinician to assess chest-pain risk and whether same-day or urgent evaluation is required.

Questions to verify

01Confirm cardiovascular history, current medications and adherence.
02Clarify duration, frequency and severity of each episode and any change over time.
03Examine and consider ECG, troponin and risk scoring as appropriate.
04Decide whether urgent or same-day cardiac assessment is required.

Transparency

The conversation records reported symptoms only; it cannot assess observations, examination or ECG findings.
Risk factors are self-reported and have not been verified against the medical record.
Clinical urgency and any decision to escalate remain for the reviewing clinician.

Potentially significant symptoms reach review with the timeline and unresolved safety work visible.

Previous case

Low mood and sleep loss expressed without clinical language.

Next case

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Voice signal animation: Carolina Cruz Barbosa / LottieFiles under the Lottie Simple License.