Cardiovascular
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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"] <-- 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


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 (age less than 55): [text]
Tobacco use: [text]
Hyperlipidemia: [text]
Hypertension: [text]
[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"]
reference: contributed by Dr. Scott Moses, creator/author of the [link url="http://www.fpnotebook.com" memo="FP Notebook Site"] Family Practice Notebook[/conditional]


[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]
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
<-- OTC NSAID's
<-- Rest
<-- exertional pain
<-- pleuritic pain

The pain is worse with
<-- supine or leaning forward ( concern for pericarditis)
<-- Rest
<-- 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


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 (age less than 55):
Tobacco use:
Hyperlipidemia:
Hypertension:
display/hide references


<-- Male 55 years or over/Female 65 or over
<-- Known CAD or cerebrovascular disease
<-- Pain not reproducible by palpation
<-- Pain worse during exercise
<-- Patient assumes pain is cardiogenic
Score --> scorescore=(Q1)+(Q2)+(Q3)+(Q4)+(Q5) out of 5. Interpretation --> interpretationscore=(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.'
display/hide references
Result - Copy and paste this output: