Lesson 1Targeted review of systems to differentiate cardiac, pulmonary, GI, musculoskeletal causesYou will practice a targeted review of systems to distinguish cardiac from pulmonary, gastrointestinal, and musculoskeletal causes, focusing on high-yield questions that refine the differential without delaying urgent care.
Cardiac ROS for ischemia and pericarditisPulmonary ROS for PE and pneumothoraxGastrointestinal ROS for reflux and ulcerMusculoskeletal and chest wall questionsPrior similar episodes and chronicityLesson 2Open-ended and presenting complaint questions (onset, character, radiation, severity, duration)This section explains how to open the interview, use open-ended prompts, and then clarify onset, character, radiation, severity, and duration. Emphasis is on avoiding bias, capturing timelines, and grading pain accurately.
Building rapport and opening the interviewUsing open-ended questions for chest painClarifying onset and temporal patternCharacter, location, and radiation of painSeverity scales and impact on functionLesson 3Associated symptoms (dyspnea, diaphoresis, nausea, syncope, palpitations)You will learn to systematically ask about shortness of breath, sweating, nausea, fainting, and palpitations, and to interpret combinations of symptoms that suggest acute coronary syndrome, arrhythmia, or alternative diagnoses.
Characterizing dyspnea and orthopneaDiaphoresis and autonomic activationNausea, vomiting, and epigastric painSyncope, presyncope, and red flagsPalpitations and arrhythmia cluesLesson 4Social history and substance use (smoking quantity, alcohol, recreational drugs, occupational, recent travel)Here you will learn to explore smoking, alcohol, and recreational drugs, as well as occupation and recent travel. Emphasis is on linking exposures to cardiovascular risk, pulmonary embolism, and other chest pain causes.
Quantifying tobacco exposure in pack-yearsAlcohol intake and cardiomyopathy riskCocaine and stimulant-associated ischemiaOccupational and environmental exposuresTravel history and venous thromboembolismLesson 5Family history of premature cardiovascular disease or sudden deathHere you will learn which family history details change risk, how to ask about premature cardiovascular disease and sudden death, and how to document ages, diagnoses, and relationships clearly and sensitively.
Defining premature cardiovascular diseaseKey questions about sudden cardiac deathDocumenting affected relatives and agesHereditary lipid and cardiomyopathy cluesHandling sensitive family discussionsLesson 6Recent infections, trauma, or surgeries and thromboembolic risk factors (immobility, cancer, estrogen use)You will learn to link recent infections, trauma, or surgery with chest pain etiologies, and to identify thromboembolic risk factors such as immobility, cancer, and estrogen use that raise suspicion for pulmonary embolism.
Recent respiratory or systemic infectionsChest trauma and musculoskeletal injuryPostoperative and immobilization risksCancer, estrogen, and thrombophilia historyWhen to suspect pulmonary embolismLesson 7Provoking/relieving factors and timing (exertion, position, meals, respiration)This section covers how exertion, position, meals, and respiration modify chest pain. You will learn to distinguish angina, pericarditis, reflux, and pleuritic pain by carefully exploring triggers, relief, and circadian timing.
Exertional angina and demand ischemiaPositional clues to pericardial diseaseMeal-related and reflux-associated painRespiratory and pleuritic pain patternsNocturnal and rest pain red flagsLesson 8Past medical history and cardiovascular risk factors (hypertension, hyperlipidemia, diabetes, prior coronary disease)This section reviews how to elicit past medical history and cardiovascular risk factors, including hypertension, high cholesterol, diabetes, and prior coronary disease, and how these modify pretest probability and urgency.
Documenting prior coronary eventsHypertension and end-organ damage historyHyperlipidemia and treatment adherenceDiabetes, kidney disease, and riskOther vascular and stroke historyLesson 9Medication, allergy, and anticoagulation history (current meds, aspirin/statin use, allergies)This section focuses on obtaining a precise medication list, including over-the-counter drugs, antiplatelets, statins, and anticoagulants, and on identifying allergies and prior adverse reactions relevant to acute chest pain care.
Verifying current prescription medicationsOver-the-counter and herbal productsAntiplatelet, statin, and anticoagulant useClarifying true drug allergies vs side effectsImplications for acute chest pain therapyLesson 10How to document and phrase questions clearly and compassionately for exam reports and handoversThis section teaches how to phrase questions clearly, avoid jargon, and maintain empathy. You will practice structuring notes, summarising key positives and negatives, and writing concise exam reports and safe handovers.
Using patient-centered, nonjudgmental languageStructuring focused chest pain questionsSummarizing key positives and negativesWriting concise exam notes and reportsSafe, structured handover communication
