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HISTORY ????..

•SITE
•ONSET
•CHARACTER
•SEVERITY
•DURATION
•RADIATION
•AGGRAVATING  FACTORS
•RELIEVING FACTORS
•ASSOCIATED SYMPTOMS
SITE


    RETROSTERNAL
PERIPHERAL
RETROSTERNAL
•CARDIAC-ANGINA,
MI,MYOCARDITIS,PERICARDITIS, MVP

•MEDIASTINAL-TRACHEITIS,MALIGNANCY


•AORTIC-DISSECTION,ANEURYSM


•ESOPHAGEAL-ESOPHAGITIS,SPASM,MALLORY
WEISS SYNDROME

•ANXIETY/EMOTION
PERIPHERAL
   LUNG/PLEURAL-
    PNEUMOTHORAX,INFARCT.

   MALIGNANCY

   MUSCULOSKELETAL-RIB#,MUSCLE
    INJURY,OSTEOARTHRITIS,OSTEOCHON
    DRITIS

   BREAST DISORDERS

   NEURALGIC-IVDP,HERPES

   ANXIETY
ONSET
   SUDDEN
    RETROSTERNAL-
    MI,PNEUMOTHORAX,PULM.
    EMBOLISM,ESOPHAG. RUPTURE
    PERIPHERAL-PNEUMOTHORAX,PE

   GRADUALLY ON EXERTION-ANGINA

   AFTER VOMITING-ESOPHAGEAL RUPTURE

   CONSTANT-
    PERICARDITIS,MUSCULOSKELETAL ,GI
OCCURING WHEN
?DURATION?
   ON EXERTION-CARDIAC PAIN

   ON FOOD INTAKE-ESOPHAGEAL

   ANGINA <20min

   MI >30min
CHARACTER & SEVERITY
   CONSTRICTING-
    CARDIAC,ESOPHAGEAL SPASM

   STABBING-PLEURAL,MUSC. SK
LEVINE’S SIGN
AGGRAVATING FACTORS
 ANGINA-
  EXERTION,EMOTION,COLD,HEAVY
  MEAL
 PERICARDITIC/PLEURITIC
SWALLOWING,MOVEMENT,COUGH’
  G,RESPIRATION
 MUSCULOSKELETAL
AGGRAVATED WITH MOVEMENT
RELIEVING FACTORS
   ANGINA-REST

   ESOPHAGITIS-
    FOOD,ANTACID,MILK

   PLEURITIC-HOLDING BREATH
ASSOCIATED SYMPTOMS
   BREATHLESSNESS-
    MI,PNEUMOTHORAX,PE

   FEVER-PERICARDITIS,PLEURITIS

   DYSPHAGIA-ESOPHAGEAL D/S

 PARAESTHESIA,HEADACHE,INSOMN.
                -ANXIETY
 PAIN &HEMATEMESIS-
  MWS,ESOPH.RUPTURE
CARDIAC PAIN   NON CARDIAC PAIN


 CENTRAL, DIFFUSE  PERIPH,LOCALIZED
 CONSTICTING        STABBING

 RADIATION          PRESENT/ ABSENT
  EXERTION,EMOTION  POSTURE, MVMT
                     NOT RELIEVED
 REST, NITRATES  SYSTEM RELATED
 BREATHLESSNESS,
 AUT
  DISTURBANCES
PAST HISTORY
 DIABETES MELLITUS
 VASCULITIS
 HYPERTENSION
 STEROIDS,OCPS
 PROLONGED BED REST/SURGERY
 TRAUMA/ASSAULT
PERSONAL HISTORY
   DIET

   SMOKING

   ALCOHOLISM
FAMILY HISTORY
 CAD
 HYPERTENSION
 DIABETES MELLITUS
 DYSLIPIDAEMIA
 COLLAGEN VASCULAR D/S
 CONGENITAL HEART D/S
TREATMENT HISTORY
   NSAIDS,ASPIRIN

   STEROIDS

   OCPs
CHEST PAIN
CARDIAC           NON CARDIAC


ISCHAEMIC      NON-ISCHAEMIC


ANGINA    MI    MYOCARDITIS
                PERICARDITIS
                 MVP
Chest Pain: Cardiac vs Non-Cardiac Causes

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