Chest Pain
Take a history of someone with chest pain in A&E. Then given their ECG - was an
MI. Had to explain management to examiner then to the patient (also breaking the
news that they had had an MI).
DD of chest pain:
Angina, gastroesophageal reflux disease, chest infection, pleurisy, PE, musculoskeletal
complaint, panic attack
1. Appropriate introduction full name and role
2. Explains purpose of interview
3. Established previous history of similar chest pain
4. Establishes onset of current chest pain
5. Establishes character of pain
6. Established severity of pain
7. Timing of pain
8. Establishes site of radiation of the pain
a. Through the back
b. Down the left arm or into the jaw
c. Retrosternal, burning pain
9. Establishes relieving factors and exacerbating factors
a. Exercise, cold air, large meals, alcohol, movement
b. Taken anything for it? (GTN spray)
10. Establishes associated factors (palpitations, sweating, nausea, dyspnoea, vomiting, fainting,
dizziness, loss of consciousness)
a. Ask specifically about nausea and vomiting, SOB, dizziness, cough, and palpitations
11. Excludes any respiratory symptoms: couch, sputum, wheeze, haemoptysis
12. Establishes presence of peripheral oedema
13. Establishes presence of orthopnoea and episodes of paroxysmal nocturnal dyspnoea
14. PMH:
a. Current, past, childhood illness
b. In particular ask about coronary heart disease, MI, angina, rheumatic fever, stroke,
intermittent claudication, hypertension, hyperlipidaemia, diabetes, smoking, and
alcohol use
c. surgery
15. Establishes associated RF of ischemic disease:
a. Smoking
b. hypertension
c. diabetes
d. Hx of IHD, PVD, stroke
e. FH of IHD, stroke
f. Alcohol excess
g. Hyperlipidaemia
h. PVD
16. DH
Take a history of someone with chest pain in A&E. Then given their ECG - was an
MI. Had to explain management to examiner then to the patient (also breaking the
news that they had had an MI).
DD of chest pain:
Angina, gastroesophageal reflux disease, chest infection, pleurisy, PE, musculoskeletal
complaint, panic attack
1. Appropriate introduction full name and role
2. Explains purpose of interview
3. Established previous history of similar chest pain
4. Establishes onset of current chest pain
5. Establishes character of pain
6. Established severity of pain
7. Timing of pain
8. Establishes site of radiation of the pain
a. Through the back
b. Down the left arm or into the jaw
c. Retrosternal, burning pain
9. Establishes relieving factors and exacerbating factors
a. Exercise, cold air, large meals, alcohol, movement
b. Taken anything for it? (GTN spray)
10. Establishes associated factors (palpitations, sweating, nausea, dyspnoea, vomiting, fainting,
dizziness, loss of consciousness)
a. Ask specifically about nausea and vomiting, SOB, dizziness, cough, and palpitations
11. Excludes any respiratory symptoms: couch, sputum, wheeze, haemoptysis
12. Establishes presence of peripheral oedema
13. Establishes presence of orthopnoea and episodes of paroxysmal nocturnal dyspnoea
14. PMH:
a. Current, past, childhood illness
b. In particular ask about coronary heart disease, MI, angina, rheumatic fever, stroke,
intermittent claudication, hypertension, hyperlipidaemia, diabetes, smoking, and
alcohol use
c. surgery
15. Establishes associated RF of ischemic disease:
a. Smoking
b. hypertension
c. diabetes
d. Hx of IHD, PVD, stroke
e. FH of IHD, stroke
f. Alcohol excess
g. Hyperlipidaemia
h. PVD
16. DH
