You are seeing Mr. Alexander, a 55 year old male, in the ER for a one week history of worsening and debilitating chest pain. Take a focused history of his complaint.
History
- Onset and duration of chest pain
- Location of pain
- Severity of pain
- Alleviating factors
- Aggravating factors, especially activity
- Frequency of chest pain
- Radiation of pain
- Association with shortness of breath
- Diaphoresis
- Palpitations
- Nausea/vomiting
- Symptoms of syncope
- Personal history of coronary artery disease and myocardial infarction
- TIA/Stroke
- Diabetes
- Dyslipidemia
- Hypertension
- Smoking history (quantity in pack-years)
- Family history of heart disease
- Effect on daily activities/occupation
- Patient’s concern as to the cause of the pain
Physical Examination
Inspection/Palpation
- Inspects precordium for scars, pulsations
- Palpates for the presence of thrills, heaves
- Palpates PMI and comments on size, amplitude, duration, and location
Carotid/JVP
- Examines JVP and comments on its estimated height
- Palpates the carotid arteries bilaterally
- Auscultates the carotid arteries for bruits
Auscultation
- Auscultates in all 4 areas of precordium with bell and diaphragm
- Comments on presence of murmurs, extra heart sounds
- Auscultates the lungs
Case 2 – Chest Pain