chest pain

onset

hours days weeks months years
sudden gradual

new?

new issue previously known issue

intensity

mild mild-moderate moderate moderate-severe severe

frequency

single episode constant intermittent daily few times a week few times a month

duration

few minutes less than an hour few hours most of the day few days

status

improving unchanged resolved gradually worsening significant worsening

context

trauma/injury yes no repetitive movement yes no

location

retrosternal sternum R pec L pec sternum R ribs L ribs

radiation

none L shoulder/arm neck back R shoulder/arm abdomen

quality

debilitating dull crushing pressure superficial sharp throbbing stabbing

timing

daytime upon awakening night time

aggravated by

nothing exertion deep breath supine leaning forward palpation after meal

relieved by

nothing rest nitro spray walking/standing lying down stretching OTC meds prescription meds

associated

cardiac hx

+ personal hx – + fam hx –

general

+ involuntary weight loss – + fever/chills – + fatigue – + weakness – + syncope –

head

+ headache – + visual changes – + hearing loss –

resp

+ cough – + sputum – + hemoptysis – + dyspnea – + wheezing –

cardio

+ chest pain – + palpitations – + SOBOE – + orthopnea – + PND – + edema –

+ abdo pain – + abdo distension – + dysphagia/odynophagia – + heartburn –
+ decreased appetite – + nausea/vomiting – + rectal bleeding –
+ constipation – + diarrhea – + jaundice –

vitals

BP:/

HR:

general

well-appearing, NAD

normal exams

eyes ears nose throat/mouth neck cardiac lungs abdomen neuro skin extremities

exam

Assessment:

cardiac risk

+ M≥55/F≥65 – + known vascular disease/CAD – + pain w palpation – + exertional –
+ pt assumes cardiogenic –

low moderate high

costochondritis GERD angina pericarditis pneumonia unknown

details

Plan

medication

tylenol PO NSAIDs trial PPI

tests

CXR bloodwork stress test echo PFTs

follow-up

2-4 weeks PRN only

RTC

instructions given

other

CHEST PAIN

S/

O/

A/

P/