History of Chest Pain
Key etiological diagnosis of chest pain - Occurs in coronary artery disease (angina, MI) and in pericarditis. Does not occur in heart failure & endocarditis.
SOCRATES S) Site
- Retrosternal
- Poor localize pain in pregnancy ; Pulmonary embolism due thrombus or Reflex GERD
- Mid-line chest pain; GERD, Esophagitis
- Pyelonephritis, Rub fructure, Muscoskeletal ((cc))
- Over skin - Herpes zoster elderly
O) Onset & character Started suddenly or gradually?
- Angina & MI is sudden pain
- Pericarditis is Gradual
- ACS
- PE
- GERD
- AD; tearing pain
- Pneumothorax
C) Character:
- Sharp pain : angina, MI
- Pricking pain: pericarditis
- Weight on the chest: angina/ MI
R) Radiation:
- radiation to the neck, left shoulder, jaw, left ⇒ arm angina/ MI
- No radiation : pericarditis
A) Associated features:
- nausea/vomiting, palpitations, sweating, dizziness ⇒ angina/MI
T) Time: How long it lasts?
- angina: lasts few minutes, comes and goes.
- MI : severe, lasts more than 10 min or so
- Pericarditis: persistent. Not “coming and going”.
E) Exacerbating/Relieving factors:
- Angina & MI exacerbated by exertion, relieved by rest
- Pericarditis : Worse by supine position, improves by bending forward
S) Severity : how bad is it on scale of 1 to 10?
- angina & MI: severe
- Pericarditis : not very severe
