Case 2 – Chest Pain

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.


  • 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


  • Inspects precordium for scars, pulsations
  • Palpates for the presence of thrills, heaves
  • Palpates PMI and comments on size, amplitude, duration, and location


  • Examines JVP and comments on its estimated height
  • Palpates the carotid arteries bilaterally
  • Auscultates the carotid arteries for bruits


  • 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