Chest Pain

HISTORY:

Chest pain for ‍ ‍hoursdays

Onset: ‍gradualsuddentraumatic, following ‍, ‍on exertionat rest

Location: ‍retrosternal

Radiation: ‍none

Severity: ‍mildmoderatesevere, ‍012345678910 / 10

Type: ‍pressureheaviness

Pattern: ‍constantintermittent

Episode duration: ‍ ‍secminhoursdaysweeksmonths

Worsening factors or triggers: ‍noneexertionmovements, ‍with deep breath, ‍with lying on back

Treatments tried: ‍none, ‍effectiveineffective

‍shortness of breath on exertion, ‍IIIIIIIV/IV

‍lower extremity edema

‍palpitations

‍syncope

‍dizziness

‍fatigue

‍nausea

‍vomiting

‍diaphoresis

‍fever

‍cough, ‍non-productiveproductive

‍sputum, ‍clearcolored

‍hemoptysis





EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Chest: ‍tenderness on ‍rightleft ‍

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍



ASSESSMENT:

‍Musculoskeletal chest pain ‍likelysuspectedpossible

DDx: ‍



PLAN:

- ECG

- Chest X-ray

- Blood work: ‍troponin, ‍d-dimers, ‍CBC, ‍lytes, ‍creatinine, ‍glucose, ‍LFTs, ‍albumin, ‍lipase, ‍CRP

- Stress test

- CT angio of the chest

- Cardiac catheterization

- Aspirin 80mg 4 tablets po STAT then 1 tablet daily

- Nitroglycerin 0.4mg sublingual q 5 min up to 3 doses

- ‍Analgesics

- Referral to cardiologist

- Referral to ER

- Follow up if does not improve or if worsens, or if new symptoms develop