Chest Pain History

Cardiovascular, Subjective/History Elements
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Chest pain
Onset [text] prior to evaluation
Onset while: [text]

Associated Pain (0=none, 10=severe)
Location: [text]
Radiation: [text]
Severity now (0-10): [text]
Severity at worst (0-10): [text]
Duration: [text]
Characterized as: [text].

The pain is relieved with [text]
[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

Pertinent Medications:
[select value="no|YES"] <-- Aspirin was taken today
[select value="no|YES"] <-- Nitroglycerin

Pitfalls:
[select value="no|YES"] <-- unilateral leg swelling
[select value="no|YES"] <-- recent prolonged travel, recent trauma, hypercoagulable state, hormonal therapy

Cardiovascular risks are reviewed as follows:
Family history of Premature CAD or CVA (<55): [text]
Tobacco use: [text]
Hyperlipidemia: [text]
Hypertension: [text]
[html]<hr>[/html][checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"][html]
reference: contributed by Dr. Scott Moses, creator/author of the <a href="http://www.fpnotebook.com" target="_blank">Family Practice Notebook</a>.[/html][/conditional]
Chest pain
Onset prior to evaluation
Onset while:

Associated Pain (0=none, 10=severe)
Location:
Radiation:
Severity now (0-10):
Severity at worst (0-10):
Duration:
Characterized as: .

The pain is relieved with
<-- exertional pain
<-- pleuritic pain

Associated Symptoms:
<-- nausea/vomiting
<-- diaphoresis
<-- shortness of breath

Pertinent PMH
<-- Coronary Disease
<-- Cerebrovascular disease
<-- Diabetes Mellitus
<-- Peptic Ulcer or GERD
<-- Chest injury or overuse

Pertinent Medications:
<-- Aspirin was taken today
<-- Nitroglycerin

Pitfalls:
<-- unilateral leg swelling
<-- recent prolonged travel, recent trauma, hypercoagulable state, hormonal therapy

Cardiovascular risks are reviewed as follows:
Family history of Premature CAD or CVA (<55): [text]
Tobacco use:
Hyperlipidemia:
Hypertension:

display/hide references
Result - Copy and paste this output:

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