Chest Pain

Chest Pain
Introduction
Greeted the patient
Introduced myself and the team
Took the patient's date of birth
Thomas Albert
He said he's 43
The patients general look
Smiling
Cooperative
Looks healthy and young
Good clothing
No face discolouration or jaundice
Normal hand shake
History of present complaint
Pain assessment (SOCRATES)
Site
Middle of the chest
Onset
Does not remember, it was usual then it got
worse in the last 2 weeks
Character
Sharp, stabbing pain
Radiation
None
Associated symptoms
Difficulty taking deep breath
Timing
30 minutes episodes, comes twice a week
exacerbating and relieving factors
None Mentioned
severity
Sever (8 out of 10)
effects on life style
Stops him during work to take a rest during the
attacks
FIFE
The patient is worried
He thinks he might have a heart problem
because his dad had one, and because he
smokes
The pain affects his functioning a little, as he
has to take a rest during the pain attack when
he's at work
Family history
No diseases run in the family
His dad had a heart attack at 64
Systematic inquiry
General symptoms
Well being
appetite
wight change
sleep
Cardio
No chest pain on exertion
Respiratory
Shortness of breath when taking deep breath
during the pain attack
No cough
No wheeze
Gastrointestinal
No Nausea or vomiting
No indigestion
No heartburn
No abdominal pain
No change in bowl habit
Genitourinary
regular urine habits
No difficulty starting or dribbing
No multiple Sexual partners
Neurological
No headaches
No dizziness
No faints or blackouts
No weakness
Musculoskeletal
No Joint pain, stiffness or swelling
No Mobility problems
Skin
No skin rash
Endocrine
No Heat or cold intolerance
No change in sweating
No excessive thirst
Drug history
Only multiple vitamins supplement, 1 pill a
day
Forgot to ask about allergies!!
Impression
Isolated musculoskeletal chest pain
syndromes
Costochondritis fits
Differential diagnosis
Cardia causes
Pulmonary causes
GI causes
Skin and sensory nerves
Rheumatic disease
Nonrheumatic systemic disease
Psychogenic causes
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