CHEST PAIN

1. When did the chest pain start?

Why: to determine if acute or chronic. If acute onset must consider heart attack,
pulmonary embolism, pneumothorax, pericarditis and rib fractures. If chest pain is
chronic must consider angina, oesophagitis, hiatus hernia and various chest wall
conditions.

2. Is the chest pain constant or intermittent?

Why: Constant pain suggests heart attack, pulmonary infarction, dissecting aneurysm and
pneumonia. Intermittent pain would suggest angina, Tietze's syndrome and Da Costa's
syndrome.

3. Where exactly is the chest pain?

Why: e.g. heart attack and angina is typically behind the breastbone; dissecting aneurysm
is behind the sternum.

4. Does the pain travel anywhere else?

Why: e.g. heart attack pain may radiate to neck, jaw and down left side of arm;
esophageal pain may radiate to throat or back; dissecting aneurysm may radiate to
between the shoulder blades, abdomen or legs.

5. Can you describe the nature of the chest pain?

Why: e.g. heart attack may be described as heavy and crushing; esophageal pain is
usually burning; dissecting aneurysm is tearing and searing.

6. What makes the pain better?

Why: e.g. if pain is relived by antacids should consider oesophagitis and hiatus hernia; if
pain is relieved by nitroglycerine spray should suggest angina but may also be spasm of
the esophagus.

7. What makes the pain worse?

Why: e.g. If the pain is precipitated or increased by breathing must consider pleurisy,
costochondritis, fractured rib and pneumothorax; if pain is aggravated by movement
suggests pericarditis; if pain is precipitated by bending, lifting, straining or lying down
and is precipitated by certain foods a possible diagnosis is esophageal reflux or spasm.

8. Is there a history of trauma to chest or back?

9. Past medical history?
CHEST PAIN
Why: e.g. diabetes, high blood pressure, high cholesterol, obesity, heart surgery,
Rheumatic fever, heart attack, asthma, emphysema, Marfan's syndrome (increases risk of
dissecting aneurysm), deep venous thrombosis.

10. Family history?

Why: e.g. heart attack, angina, heart bypass surgery.

11. Coughing up blood?

Why: must consider pulmonary embolism.

12. Fever and pus-like sputum

Why: should consider pneumonia.

13. Shortness of breath?

Why: should consider pneumothorax, pulmonary embolism, pneumonia and congestive

heart failure due to heart attack.

14. Acid or bitter taste in mouth?

Why: may suggest reflux oesophagitis.

15. Rash in area of pain?

Why: suggests herpes zoster (shingles).

16. Symptoms of anxiety?

Why: e.g. nervousness, tremor, palpitations, shortness of breath, rapid breathing.