CHEST PAIN

CHIEF COMPLAINT

Chest pain

HPI
1. Concern: Chest pain
2. Onset-Sudden/ Gradual
3. Duration: ____
o Recent
o A few days
o Many days
o A few weeks
o Many weeks
o A few months
o Many months
o A few years
o Many years
o Recurrent
o n/a.

4. Severity:
o Mild
o Moderate
o Severe
o Absent
o Normal
o Increased
o Decreased
o Stable
o No significant change from prior visit.
o Details
5. Location: Left/ Right/ Bilateral
6. Radiation:
1. Neck
2. Jaw
3. Left arm
4. Retrosternal
5. Shoulder
6. Outer ear
 7. Quality :
o Improving
o No change
o Worsening
o Burning pain
o Constricting
o Crushing
o Dull pain
o Heavy
o Sharp pain
o Squeezing
o Stabbing
o Suffocating
o Pleuritic

8. Frequancy
9. Status
10.Context
11. Aggravated by :
1. exertion
2. eating heavy meals
3. emotional stress
12. Relieved by
13.Associated Symptoms
• Sweating
• Nausea
• Palpitations
• Dizziness
• Shortness of breath
• A "sense of impending doom."
• Cough
14.Pertinent Negatives
15.Notes

HISTORY (PMFSH)

PAST HISTORY
•Diabetes mellitus
•Hypertension
•Anemia
 •Coronary heart disease
•Heart valve problem

FAMILY HISTORY
•Diabetes mellitus
•Hypertension
•Coronary heart disease

ALLERGY-Drugs
-Environment

SOCIAL HISTORY

Habits
•Alcohol
•Caffeine use
•Drugs____
•Tobacco
Occupation____

ROS

PHYSICAL EXAMINATION

SPECIFIC DATA LIKE GRADING ETC

TESTS TO BE ORDERED

•Blood tests:
o Complete blood count
o Electrolytes
o Creatinine
o Liver enzymes
o Creatine kinase
o CK-MB fraction
o Troponin I or T
o D-dimer
o Serum amylase
o LDH
o LDH isoenzymes
o CPK
o CPK isoenzymes
 •Urine test
•Cardiac catheterization
•ECG
•Exercise ECG
•Angiography
•Transesophageal echocardiography
•2D Echo
•X-ray
o Chest
o Abdomen
•CT scan
o Chest
o Abdomen
•V/Q scintigraphy / CT pulmonary angiogram
•MRI

DIFFERENTIAL DIAGNOSIS

•Cardiopulmonary

o "Stable" Angina Pectoris

o Acute coronary syndrome
o Myocardial infarction ("heart attack")
o Aortic dissection
o Pulmonary embolism
o Pneumonia
o Hemothorax
o Pneumothorax
o Arrhythmia
•Poisoning

o Carbon Monoxide Poisoning

o Lead Poisoning
•Gastrointestinal

o Gastroesophageal reflux disease (GERD)

o Hiatus hernia
o Achalasia
o nutcracker esophagus
o Functional Dyspepsia
•Problems of outer chest structures
 o Tietze's syndrome
o Spinal nerve problem
o Fibromyalgia
o shingles
•Others

o Hyperventilation syndrome
o Da costa's syndrome
o Bornholm disease
o Precordial catch syndrome
o Pleurisy
o High abdominal pain
•Psychological
o Panic attack
o Anxiety
o Clinical depression
o Somatization disorder
o Hypochondria

ASSESSMENT/PLAN & PATIENT EDUCATION:

o Lose weight, don’t smoke, eat a low-salt, low-fat diet, and
avoid physical and emotional stresses
o Practice relaxation techniques
o Periodic screening for diabetes mellitus
o Periodic screening for hypertension

MEDICATION
o Aspirin
o Clopidogrel
o Metoprolol
o Atenolol
o Propranolol
o Amlodipine
o Diltiazem
o Verapamil
o Nitroglycerin
o Isosorbide
o Isosorbide mononitrate
o Ramipril
o Ranolazine
 o Ibuprofen
o Flurbiprofen
o Ketoprofen
o Naproxen

FOLLOW-UP