Lesson 1Targeted review of systems to differentiate cardiac, pulmonary, GI, musculoskeletal causesPractise a focused systems review to separate heart from lung, stomach, and muscle issues, using key questions that narrow possibilities without holding up emergency 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)Learn to start the chat openly, use broad prompts, then pinpoint start time, nature, spread, intensity, and length. Focus on steering clear of prejudice, noting timelines, and rating pain properly.
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)Systematically ask about breathlessness, sweating, sickness, fainting, and irregular beats, interpreting symptom mixes pointing to heart attack, rhythm issues, or other 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)Explore smoking habits, booze, street drugs, job type, and recent trips. Link these to heart risks, lung clots, and other chest pain triggers.
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 deathIdentify family details that raise risk, ask sensitively about early heart issues or sudden passing, and record ages, conditions, and relations clearly.
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)Connect recent bugs, injuries, or ops to chest pain causes, spotting clot risks like bed rest, tumours, or hormone pills that hint at lung clots.
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)See how effort, posture, food, and breathing affect chest pain. Differentiate angina, heart lining inflammation, acid reflux, and lung pain via triggers, relief, and daily patterns.
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)Elicit old health issues and heart risks like high BP, high fats, sugar disease, past blockages, and how they shift odds 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)Get exact med lists including shop-bought pills, blood thinners, cholesterol meds, and note allergies or bad reactions key for chest pain handling.
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 handoversPhrase queries simply, skip medical jargon, keep empathy. Practise note structure, key yes/no points, and crisp reports for safe shifts.
Using patient-centered, nonjudgmental languageStructuring focused chest pain questionsSummarizing key positives and negativesWriting concise exam notes and reportsSafe, structured handover communication
