Archive:Chest pain: Difference between revisions

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Revision as of 04:30, 16 May 2007

1. ID: name, AGE

2. HPI

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, anxiety, sour-taste
T = timing
- Describe the course of the pain. (worsening, intermittent, better)
- Timing of day.
V = déjà vu
- Have you felt similar symptoms before?

3. 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

4. Medication/allergies

5. ROS:

syncope, exercise intolerance, PND/orthopnea, angina, CVA

6. Impression:

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

7. 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

10. Canadian Cardiovascular Society (CCS) Classification

@@ Line 1: / Line 1: @@
+. ID: name, AGE
+. HPI
+*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, anxiety, sour-taste
+*T = timing
+**Describe the course of the pain. (worsening, intermittent, better)
+**Timing of day.
+*V = déjà vu
+**Have you felt similar symptoms before?
+. 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
+. 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
+. Canadian Cardiovascular Society (CCS) Classification
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Revision as of 04:30, 16 May 2007