Lesson 1Targeted review of systems to differentiate cardiac, pulmonary, GI, musculoskeletal causesPractice a focused systems review to separate heart from lung, stomach, or muscle issues, using key questions that sharpen your diagnosis list without slowing down urgent treatment.
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 interviews openly, then pinpoint onset, nature, spread, intensity, and length of pain. Focus on steering clear of assumptions, 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 check for shortness of breath, sweating, nausea, fainting, and irregular heartbeat, interpreting symptom mixes that point to heart attacks, rhythm problems, or other issues.
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, alcohol intake, drugs, job risks, and recent trips, connecting 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 risks, ask sensitively about early heart disease or sudden deaths, 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 illnesses, injuries, or operations to chest pain causes, spotting clot risks like bed rest, cancer, or hormone therapy that suggest 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, or breathing affect pain. Distinguish heart squeeze, heart sac inflammation, acid reflux, or lung lining pain through 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)Gather background health and heart risks like high blood pressure, high cholesterol, sugar diabetes, and past heart issues, adjusting your suspicion and response speed.
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 an exact list of medicines, including shop-bought ones, blood thinners, cholesterol pills, noting allergies and bad reactions key to chest pain treatment.
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 questions plainly, skip medical jargon, show care. Practice notes, highlight key yes/no findings, and craft short reports and safe shift handovers.
Using patient-centered, nonjudgmental languageStructuring focused chest pain questionsSummarizing key positives and negativesWriting concise exam notes and reportsSafe, structured handover communication
