steps to take history of chest pain with presented case

1. HISTORY
TAKING:
CHEST
PAIN

2. OBJECTIVES OF HISTORY
TAKING





To make a DD or Dx
Ta assess FUNCTIONAL CAPACITY
To establish a meaningful Dr Pt rapport
To develop a problem list
To assess socio-economic status and
preferences

3. OVERVIEW OF HISTORY
CHIEF COMLPLAINT
 HISTORY OF PRESENT ILLNESS
 PAST HISTORY
 FAMILY HISTORY
 SOCAIL HISTORY
 DRUG HISTORY
 REVIEW OF SYSTEMS


4. PRESENTING COMPLIANT
Mr. Aslam 50 year old ,male ,
labourer by profession, resident of
peoples colony presented in
emergency on 15 December with the
CHIEF COMPLAINT of chest pain for 4
hours


5. What diagnosis comes in
your mind?

6. DIFFERENTIAL DIAGNOSIS
Cardiac cause
 Respiratory cause
 Musculoskeletal cause
 GI and Mediastnal causes


7. DIFFERENTIAL DIAGNOSIS

•
•
•
•
CARDIACAngina
Myocardial infarction
Pericarditis
Myocarditis

8. 
•
•
•
•
RESPIRATORYPneumothorax
Pulmonary embolism
Tracheitis
Pleuritis

9. 
•
•
•
•
GI AND MEDIASTNALAortic dissection or aneurysm
Esophagitis
Esophageal rupture
Esophageal spasm

10. 
•
•
•
•
•
MUSCULOSKELETALSoft tissue and bone injury
Osteochondritis
Osteoarthritis
Herpes zoster
REFERRED PAIN

12. HISTORY OF PRESENT
ILLNESS
When was the patient well last?
2 months ago
1.
SETTING(Onset):pain was
SUDDEN when patient woke up in
the morning
2.
INTENSITY: pain was SEVERE

13. 3.
SITE AND RADIATION: pain was
CENTRAL, radiating to left arm and
jaw
4.
DURATION: from last four hours

14. 5.
6.
CHARACTER: pain was
CONSTRICTING and SQUEEZING
in nature
ASSOCIATED COMPLAINT:
palpitation, BREATHLESSNESS,
sweating, nausea,and feeling of
anxiety

16. o
MODIFYING FACTORS:
Aggravating factor
Relieving factors

For the history of pain we use acronym
7.
o
SOCRATES.

17. PAST HISTORY
MEDICALhypertensive
diabetic
 SURGICAL- no


18. PERSONAL HISTORY
SMOKER from last 15 years
 No other HO of drug addiction


19. FAMILY HISTORY
Family history of
•
diabetes
•
hypertension
•
ischemic heart disease
 Father died of MI 15 year back


20. DRUG HISTORY
Anti-hypertensive
 Metformin for diabetes


21. SUMMARAY OF HISTORY
Ideas
 Concerns
 Expectations
