I was on a night shift a few weeks ago. I had actually come in feeling quite refreshed, which doesn’t always happen with night shifts. I had slept well, felt clear in my head, and for once I thought, this might be a decent shift. The department was not too busy yet, and I was in a good mood when I called my first patient.
He was a 34-year-old man who had come in with shortness of breath and occasional chest pain. He looked well when he walked in. Not someone you would immediately think was seriously unwell, but he looked worried, and you can usually tell when someone is genuinely concerned about what they are feeling.
I asked him what had been going on. He said, “I’ve been getting short of breath for a few weeks… and sometimes I get this chest pain. It comes and goes.”
I asked the usual questions.
When did it start? What makes it worse? Any medical problems before? Any medications? Everything sounded quite straightforward at first. His observations were normal. He was not in distress. His blood tests and ECG that had already been done in A&E were normal too.
Then I asked the question we always ask, sometimes without thinking much about it.
“Any family history of heart problems?”
He paused before answering. “My dad died when he was 29.” That made me stop typing for a moment. “Do you know what happened?” I asked.
“They said it was his heart. He had chest pain for a few weeks, then one day he just collapsed, my mom said”
I asked if anyone else in the family had heart problems.
He said, “My grandfather died at 48. Two of my uncles too, and they died before the age of 50. I was told they had all complained of chest and body pain before they died.” At that point the whole conversation changed. You could tell this was the real reason he had come in.
I asked him, “Is that what’s worrying you now?”
He nodded straight away. He proceeded to tell me how he got married a little over a year ago and his wife was a few months pregnant.
“I keep thinking… what if the same thing is happening to me? I had never given it much thought until now”
The difficult(or good) thing was that all his tests in A&E were normal. His bloods were fine. ECG fine. Chest X-ray fine. He didn’t look like someone having a heart attack, and there was nothing obvious to explain his symptoms.
But the family history didn’t sit right at all.
I told him, “I think we should refer you to the cardiac clinic to look into this properly. And given your family history, you may also need genetic testing to see if there’s something inherited going on.” He actually looked relieved when I said that.
He told me none of the men in his family had ever been given a proper diagnosis.
“It all happened too fast,” he said. “They complained of chest pain… then they died. No one ever found out why.”
After he left, I sat there for a moment before calling the next patient. It made me think about inheritance. When people talk about inheritance, they usually mean money, property, or things passed down from parents to children. But in medicine, you realise people inherit other things too, and they don’t get a choice about it.
Some people inherit eye colour. Some inherit height. Some inherit tempers, or anxiety, or the way they laugh. And some inherit risks they don’t even know about until something starts to happen.