Chest Pain

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 o o o •Others

Tietze's syndrome Spinal nerve problem Fibromyalgia shingles

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 o o o

Ibuprofen Flurbiprofen Ketoprofen Naproxen

FOLLOW-UP