Chest Pain

Chest pain
Onset [text] prior to evaluation
Onset while: [text]

Associated Pain
Location: [text]
Radiation: [text]
Severity now: [text]
Duration: [text]
Characterized as: [text].

The pain is relieved with [text]
[select value="no|YES"] <-- OTC NSAID's
[select value="no|YES"] <-- Rest
[select value="no|YES"] <-- exertional pain
[select value="no|YES"] <-- pleuritic pain

The pain is worse with [text]
[select value="no|YES"] <-- supine or leaning forward ( concern for pericarditis)
[select value="no|YES"] <-- Rest
[select value="no|YES"] <-- exertional pain
[select value="no|YES"] <-- pleuritic pain



Associated Symptoms:
[select value="no|YES"] <-- nausea/vomiting
[select value="no|YES"] <-- diaphoresis
[select value="no|YES"] <-- shortness of breath

Pertinent PMH
[select value="no|YES"] <-- Coronary Disease
[select value="no|YES"] <-- Cerebrovascular disease
[select value="no|YES"] <-- Diabetes Mellitus
[select value="no|YES"] <-- Peptic Ulcer or GERD
[select value="no|YES"] <-- Chest injury or overuse
[select value="no|YES"] <-- ETOH use


Pt does not have recent prolonged travel, recent trauma, hypercoagulable state, hormonal therapy or hx of blood clots in the family.


Cardiovascular risks are reviewed as follows:


[select name="Q1" value="no=0|YES=1"] <-- Male 55 years or over/Female 65 or over
[select name="Q2" value="no=0|YES=1"] <-- Known CAD or cerebrovascular disease
[select name="Q3" value="no=0|YES=1"] <-- Pain not reproducible by palpation
[select name="Q4" value="no=0|YES=1"] <-- Pain worse during exercise
[select name="Q5" value="no=0|YES=1"] <-- Patient assumes pain is cardiogenic
Score --> [calc value="score=(Q1)+(Q2)+(Q3)+(Q4)+(Q5)" memo="score"] out of 5. Interpretation --> [calc value="score=(Q1)+(Q2)+(Q3)+(Q4)+(Q5);score>3?'High (62.7%) risk, proceed with ACS evaluation.':score>1?'Moderate (12.1%) risk, obtain ECG and proceed with ACS or other evaluations as indicated.':'Low (0.6%) risk, if no other indication of cardiac cause, evaluate for non-cardiac causes.'" memo="interpretation"]
[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"]
reference: AAFP Point-of-Care Guide at [link url="http://www.aafp.org/afp/poc" memo="Ebell (2011) Am Fam Physician 83: 603-5"][/conditional]



Pt denies fever, diaphoresis, rash, palpitations, dyspnea, orthopnea, PND, cough, sputum, hemoptysis, abdominal pain, nausea, vomiting, dysphagia, syncope, lower extremity pain.

Differential: Heart/ vascular: Angina MI Acute pericarditis Aortic dissection Lungs: Pneumonia PE Pneumothorax. GI: GERD Peptic ulcer disease Pancreatitis Diffuse esophageal spasm. Other: Costochondritis Rib fracture Anxiety Herpes zoster Skin lacerations Muscle strain.