Archive:Chest pain
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/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?
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
Other OSCE modules
Acute Confusion - Acute Coronary Syndrome Orders - Anemia - Arterial Blood Gasses - Asthma - Blood Pressure - Chest pain - Chest XRay - CHF - Coma - COPD - Cranial Nerves - Diabetic History - Diabetic Foot - Dysphagia - EKGs - Gallbladder and Liver - Liver Disease - Gait and Balance - Headache - Hematemesis - Hypertension - Jugular Venous Pulses - Knee Exam - Lymph Nodes - Community Acquired Pneumonia - Parkinson Disease - Peripheral Arterial Insufficiency - Pneumonia Examination - Precordial Exam - STD's - Spleen - Swollen Leg Exam - Thyroid Exam - Upper vs Lower Motor Neuron Lesions - Urinary Incontinence