Chest pain

DDx

• Cardiac – Angina, AMI, aortic dissection, aortis, aneursymal rupture pericarditis, myocarditis, pericardial tamponade
• Respiratory - PE, pneumonia, pneumothorax, COPD(with bullae rupture), mediastinitis
• Gastro - GORD, Ulcer, Oesophageal spasm, FB, oesophageal rupture
• Musculoskeletal - Muscle strain, Cosotochondritis, rib fracture

History:

HOPC

• When did it happen?
• What were you doing at that time?
• Describe the chest pain? Site, radiation Severity, quality, duration, Agg/relief.
• Associated symptoms.
• Chest pain/Palpitations/SOB
• Chest infections? Fever/chills/rigors. Cough/wheeze/sputum production
• Burning sensation after a heavy meal? History of heart burn?
• Recent chest trauma, muscle strains, heavy lifting
• Recent surgery, calf tenderness, immobility

Med hx

• CVD rf – smoke, drink, HT, DM, hypercholesterolemia, FH

FH

• Heart problems
• Clotting problems

O/E

Descrip

V/S- HR + regular, PR, RR, oxygen sats, temp

Cardioresp

• No peripheral signs of anemia, no clubbing, (no hepatic flap, HPOA, -ve pemberton’s sign, dupetryon’s contracture. No stigmata of infective endocarditis)
• Apex beat not displaced. No thrills or heaves. Heart sounds dual, no murmers. JVP not elevated. Carotid pulses clear. Lung bases clear. No peripheral odema. No local calf tenderness.
• Chest expansion equal&normal. No stridor. Trachea midline, not deviated. Normal to percussion. No wheeze, crackles

GIT, musculoskeletal.

“I wasn’t driven into medicine by a social conscience but by rampant curiosity” - Dr Jonathan Miller