View source for Archive:Chest pain

==ID==
*name, AGE

{{ntnes}}
=='''SOAP'''==
-HPI-
'''Subjective'''
*O = onset
**Sudden or gradual onset?
*P = precipitating
**What were you doing when pain came on?
**palliation
***NO, antacids, rest, positional
**provocative
***exercise,  food,  emotion, deep breaths
*Q = quality
** sharp, dull, heavy, squeezing, tearing
*R = radiation	
**Point to where pain is and goes. (neck, jaw)
*S = symptoms, severity
**sweating, SOB, palpitations, cough, syncope/presyncope, anxiety, sour-taste, nausea	
*T = timing
**Describe the course of the pain. (worsening, intermittent, better)
**Timing of day.
*V = déjà vu
**Have you felt similar symptoms before?
<br>
'''Objective'''
-PMHx-

*Previous similar episodes? (past therapy, investigations)

*Hx: MI, documented CAD, angioplasty, CABG
*Important historical risk factors
**Smoking
**Hypertension
**Diabetes mellitus
**hypercholesterolemia
**positive family history
	
==Medication/allergies==
'''Assesment'''
==ROS==
*syncope, exercise intolerance, PND/orthopnea, angina, CVA

==Impression==
*Is the chest pain typical or atypical for angina?
** look at the ECG, cardiac enzymes, CXR 

==Differential Diagnosis==
*CV: stable or unstable angina (< 10 min, worsened by cold air, stress) 
*IHD (> 30 min, unrelieved)
*aortic dissection
*pericarditis (hrs to days, relieved by sitting up and leaning forward)

*RESP: pneumothorax, PE, pleuritis
*GI: GERD, PUD, esophageal spasm
*MSK: costochondritis, rib fracture
*MISC: panic attack, herpes zoster

'''Plan'''

==Canadian Cardiovascular Society (CCS) Classification==
# Angina only with strenuous, rapid or prolonged activity 
# Angina only slightly limiting ordinary activity, such as walking up-hill, climbing stairs rapidly, or climbing more than 2 blocks on the level, at a normal pace. 
# Angina with level walking at normal pace for less than 1-2 blocks, or less than 1 flight of stairs 
# Inability to carry on any physical activity without developing angina

==Other OSCE modules==
{{OSCE2}}
[[Category:OSCE]][[Category: Cardiovascular Medicine]]