Chest Pain

HISTORY_LIST
***** HISTORY OF PRESENT ILLNESS
duration of pain
location
radiation
character
intensity
rate of onset
pain with activity
relief by nitroclycerine
relief by rest
relief by antacids
increased comsumption of
nitroglycerine tablets
increase in frequency of pain
increase in severity of pain
improvement of pain since onset
worsening of pain since onset
occurence during rest or sleep
diaphoresis
nausea
vomiting
dyspnea
orthopnea
doe
edema
leg pain
weakness
hemoptysis
dysphagia
cough
sputum
paresthia of arm, hand or face
syncope
exacerbation by
   inspiration
   cough
   position
arm
chest
neck
back movement
eating
anxiety
sexual intercourse
exacerbation by exposure to 
cold or heat
exacerbation by aspirin
nsaids, or cocaine
***** HISTORY
CHRONIC DISEASE
SYSTEMIC DISORDERS
claudication
diabetes
exercise intolerence
hx of a stroke
pud
melena
abdominal pain
bleeding risk factors
hyperuricemia
peripheral vascular disease
premenopausal
postmenopausal
smoking
PREVIOUS TESTS
stress testing
angiogram
nuclear scan
EGG
FAMILY HISTORY
family hx of coronary artery
    disease before age 55
diabetes
HTN
hypercholesterolemia

MEDS_LAB_TESTS
***** MEDS
nitroglycerine
beta blockers
heparin
ASA
calcium channel blockers
ranitidine
noncompliance with 
antihypertension medications
bronchodilators
amphetamines
NSAIDS
oral contraceptives
antidepressants
steroids
tricyclics
MAO inhibitors
**** LAB
CPK
MB fraction
LDH
Mg
CBC
Electrolytes
***** TESTS
R/O MI
ECG
ST elevation ( 0.1 mV in one,
  or more limb leads or, 1.5 
  - 2.0 mV in one or, more V 
  lead T wave inversions)
Horizontal ST segment depression
  of 1.0-2.0 mV in, both limb and
  precordal,leads (subencardial 
  infarction)
CXR shows cardiomegaly and 
  pulmonary edema

REVIEW_OF_SYSTEMS_1
GENERAL
weight changes
appetite changes
anorexia
difficulty sleeping
fever
chills
polyphagia
hypophagia
changes in thirst
sleeping habit change
bowel habit change
fatigue
hypertension
previous physical exams
SKIN
pigmentation changes
texture changes
lesions
eruptions
pruritis
easy bruising
easy bleeding
unusual hair loss
changes in hair distribution
skin masses
finger/toe nail change
rashes
hives
striae
skin atrophy
uremic frost
hirsutism
plethora
neurofibromatosis lesion
HEENT
head trauma
skull fractures
head masses
hearing loss
vertigo
chronic ear infection
ear discharge
ear pain
hearing aid use
loss of vision
recent change in vision
photophobia
diplopia (double vision)
glaucoma
exudates
dry eyes
eye pain
cataracts
eye surgery
itchy eyes
excessive tearing
corrective lenses
nose bleeds
chronic sinusitis
nasal fractures
nasal drainage
polyps
changes in sense of smell
edentulous (without teeth)
partial plate
full plate
recent dental work
oral lesions
tonsillitis
strep throat
tongue problems
voice changes
chronic hoarseness
chronic halitosis
NECK
neck masses
enlarged thyroid gland
brachial cleft cysts
neck injury

REVIEW_OF_SYSTEMS_2
VITALS
BP in both arms
Postural BP
Pulse
Temp
Heart rate
GENERAL
visible pain
apprenhension
respiratory distress
pallor
SKIN
cold extremities
xanthomas
HEENT
fundi
silver wire
arteries
fundi arteriolar narrowing
fundi A-V nicking
hypertensive retinopathy
carotid pulse amplitude
carotid pulse duration

REVIEW_OF_SYSTEMS_3
CHEST
chronic coughing
sputum production
hemoptysis
wheezing
pneumonia
bronchitis
TB
TB exposure
SOB (altered by position?)
edema
chest pains
pacemaker
HEART
MI
coronary artery disease
heart murmur
heart valve disease
left ventricular hypertrophy
mistral valve stenosis
pericarditis
palpitations
DOE
paroxysmal nocturnal dyspnea
orthopnea
edema
hypertension
rheumatic fever
cardiomyopathy
ectopic heart beats
arrhythmia
exercise intolerance
claudication
heart medications
ABDOMEN
abdominal pain
nausea
vomiting
diarrhea
constipation
hematochezia
hematemesis
hemorrhoids
GI x-rays
GI scopings
rectal bleeding
ulcers
bowel polyps
bowel incontinence
gall bladder disease
gall stones
hepatitis
cirrhosis
hepatomegaly
splenomegaly
GU
renal insufficiency
renal failure
dialysis
kidney stones
kidney disease
kidney cyst
flank pain
hematuria
pyuria
dysuria
chronic cystitis
nocturia
anuria
hesitancy
enuresis
change in urine color
prostatitis
epididymitis
scrotal problems
TURP
pain on intercourse
genital lesions
genital discharge

PHYSICAL_EVAL_1
CHEST
crackles
wheezes
percussion note
friction rub
HEART
decreased intensity of S1
paradoxical splitting of S2
presence of S3
presence of S4
chest wall tenderness
dyskinetic cardiac impulse
enlarged apical impulse
prolonged apical impulse
displaced apical impulse
Levine's sign (patient with
   clenched fist over sternum)
ABDOMEN
epigastric tenderness
pulsatile mass
hepatomegaly
RECTAL
occult bleeding
EXTREMITIES
edema
extent of edema
unequal pulses
femoral bruitis
deminished pulses
calf pain and swelling
xanthomas (lipid deposits
   over tendons)
elevation pallor of legs
   and feet

PHYSICAL_EVAL_2
OB/GYN
metorrhagia
menorrhagia
irregular menses
problems in pregnancy
use of contraception
breast masses
nipple discharge
breast skin changes
changes in axillary nodes
monthly breast exam
breast feeding children
EXTREMITIES
difficulty with gait
weakness
joint swelling
joint stiffness
muscle pain
muscle swelling
muscle injuries
agittal plan scoliosis
coronal plane scoliosis
fractured bones
SLE
osteoarthritis
rheumatoid arthritis
fibromyalgia
NEURO
seizures
head injury
LOC
loss of coordination
difficulty in balance
sciatica
difficulty in fine motor skills
difficulty speaking
CVA (stroke)
weakness in arms
weakness in legs
tingling in legs and feet
tingling in arms
PSYCHIATRIC
depression
bipolar disorder
suicide attempts
hospitalization for, 
   psychiatric problems
personality disorders
ENDOCRINE
goiter
exophthalmos
dry skin
dry hair
intolerance to heat
intolerance to cold
changes in growth
sterility
impotence
decreased libido
LYMPHATIC AND HEMATOLOGICAL
lymphadenopathy
transfusion
anemia

DIFF_DIAGNOSIS
MI
PE
PUD
Gastritis
Aortic dissection
Pericarditis
Pleurisy
Cardiomyopathy
Esophagitis
Espohageal,spasm,tear,rupture
Mitral Valve Prolapse
Pulmonary Hypertension
Psychogenic pain
Pneumothorax
Musculskeletal chest wall pain
Costrochondritis,(Tietze's 
  syndrome)
Osteoarthitis of the spine 
  or shoulder
Hiatal hernia
Pancreatitis
Cholycystits
Bronchitis
Pneumonia
Pleuritis
MalignancyBreast disease
Intercostal neuritis (Zoster)

