history taking : Chest pain

HISTORY TAKING:CHEST PAIN

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

OVERVIEW OF HISTORY

CHIEF COMLPLAINT HISTORY OF PRESENT ILLNESS PAST HISTORY FAMILY HISTORY SOCAIL HISTORY DRUG HISTORY REVIEW OF SYSTEMS

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

What diagnosis comes in your mind?

DIFFERENTIAL DIAGNOSIS

Cardiac causeRespiratory causeMusculoskeletal causeGI and Mediastnal causes

DIFFERENTIAL DIAGNOSIS

CARDIAC-• Angina• Myocardial infarction• Pericarditis• Myocarditis

RESPIRATORY-• Pneumothorax• Pulmonary embolism• Tracheitis• Pleuritis

GI AND MEDIASTNAL-• Aortic dissection or aneurysm• Esophagitis• Esophageal rupture• Esophageal spasm

MUSCULOSKELETAL-• Soft tissue and bone injury• Osteochondritis• Osteoarthritis• Herpes zoster• REFERRED PAIN

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

3. SITE AND RADIATION: pain was CENTRAL, radiating to left arm and jaw

4. DURATION: from last four hours

5. CHARACTER: pain was CONSTRICTING and SQUEEZING in nature

6. ASSOCIATED COMPLAINT: palpitation, BREATHLESSNESS, sweating, nausea,and feeling of anxiety

7. MODIFYING FACTORS:o Aggravating factoro Relieving factors

For the history of pain we use acronym SOCRATES.

PAST HISTORY

MEDICAL- hypertensive diabetic SURGICAL- no

PERSONAL HISTORY

SMOKER from last 15 years No other H\O of drug addiction

FAMILY HISTORY

Family history of• diabetes• hypertension• ischemic heart disease Father died of MI 15 year back

DRUG HISTORY

Anti-hypertensive Metformin for diabetes

SUMMARAY OF HISTORY

IdeasConcernsExpectations