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1)Chest Pain
1) SOCRATES
1)
2)
3)
4)
Site
Onset
Character
Radiation
Under arm, stomach
5) Associated symptoms
Nausea, Vomiting, Dizziness, Anxiety, Doom
Breathlessness - angina
Heartburn/acid reflux
6) Timing
Has it happened before
7) Exacerbating/Alleviating factors
Breathing in/out
Posture eg. leaning forward
8) Severity
2) Red Flags
1)
2)
3)
4)
5)
6)
7)
8)
9)
Orthopnoea - pillows
SOB - exertion
Sudden SOB at night - PND
Palpitations
Swelling
Chest Pain
Dizziness/Syncope
Ankle Swelling
Claudication - pain when walking
2)
3)
4)
5)
GTN
Statins
Diuretics
Beta-blockers or Beta-Agonists for asthma
5) Family History
1)
2)
3)
4)
Stroke
MI
Angina
Hypercholesterolaemia
6) Social History
1) Smoking
2) Alcohol
3) Recreational Drugs
Cocaine
Amphetamines
7) Main DIfferentials
1)
2)
3)
4)
5)
MI
Angina
Pericarditis
Aortic Dissection
GORD
6) Musculoscheletal pain
7) Pneumothorax
2)Breathlessness
1) History
1) Onset
Gradual or sudden
What activity were they doing
2)
3)
4)
5)
6)
7)
Duration
Progression (getting worse?)
What brings it on?
PND - pillows
Exercise tollerance
Any accompanying symptom
Chest pain
Haemoptysis
Cough
Palpitations
Wheeze
2) Red Flags
1) Chest Pain
2) Swelling
3) Haemoptysis
4) Persistent Cough
5) Wheeze
4) Drugs
1) Nebulisers
2) Amiodarone - pulmonary fibrosis
3) Inhalers/Home O2
5) Family History
1) Heart Failure
2) Heart conditions
3) Asthma/Allergy
6) Social History
1) Smoking
2)
3)
4)
5)
Exposure to Asbestos
Exposure to TB
Recent travel
Does breathlessness interfere with activities?
7) Main Differentials
1)
2)
3)
4)
5)
6)
7)
8)
9)
Angina
MI
Pneumothorax
Pulmonary Oedema - Heart Failure
Fibrosis
Infection
COPD
Asthma
Metabolic Acidosis
3)Palpitations
1) History
1)
2)
3)
4)
Sweat
Breathlessness
Chest Pain
Loss of consciousness
5) Rate (fast/slow)
6) Regular or irregular
7) Signs of Thyrotoxicosis
tremor
sweaty
goitre
eye signs
Hot/cold tolerance
2) Red Flags
1)
2)
3)
4)
Chest Pain
Orthopnea
Breathlessness
Swelling
4) Drugs
1) Any drugs that could cause electrolyte imbalances? (loop
diuretics)
2) Anticoagulants
3) Beta agonist inhalers
5) Family History
1) Family history of syncope or sudden death
2) Family history of heart disease
6) Social History
1) Smoking
Including e-cigarettes or nicotine patches
2)
3)
4)
5)
Alcohol
Caffeine
Job and stress
Recreational drugs
cocaine and amphetamine
7) Main Differentials
1) Cardiac Diseases
IHD
Hypertension
Atrial fibrillation
2) Thyrotoxicosis
3) Anxiety
Systems Review
GI
Difficulty Swallowing
Abdominal Pain
Respiratory
SOB
Cough
Chest Pain
Wheeze
Genitourinary
Change in frequency
Blood in urine
Musculoskeletal
Joint pain
Muscle pain
CNS
Headaches
Dizziness
Faints
Fits
Weakness
Visual Disturbances