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Chest Pain – History

Free medical revision on chest pain history taking skills for medical student exams, finals, OSCEs and MRCP PACES


Introduction (WIIPP)

  • Wash your hands
  • Introduce yourself: give your name and your job (e.g. Dr. Louise Gooch, ward doctor)
  • Identity: confirm you’re speaking to the correct patient (name and date of birth)
  • Permission: confirm the reason for seeing the patient (“I’m going to ask you some questions about what’s brought you in here today, is that OK?”)
  • Positioning: patient sitting in chair approximately a metre away from you. Ensure you are sitting at the same level as them and ideally not behind a desk.


Presenting Complaint and History of Presenting Complaint

  • Chest pain is an excellent example of when to use the mnemonic “SOCRATES”:
  • Site (central or left sided chest pain, retrosternal pain, epigastric pain)
  • Onset (sudden onset, how quickly it progressed, relation to exertion [if related to exertion, is it always related to exertion or occasionally at rest])
  • Character (crushing, heavy, tight, pleuritic [worst with breathing], burning)
    • Some patients may struggle to explain the character of their pain.  If this the case, give them a list of options (e.g. tight, sharp, dull or burning)
  • Radiation (radiating to left arm, neck, jaw [ACS]; back [pancreatitis, aortic dissection])
  • Alleviating factors (rest, glycerol trinitrate [GTN – suggestive of  ACS]; sitting forward [pericarditis])
  • Timing (relation to exertion or food; any positional element)
  • Exacerbating factors
    • Arm movement, pressing on chest (suggests musculoskeletal)
    • Exercise, effort (suggest cardiac)
  • Severity scale (1-10)
  • Associated symptoms
    • Acute coronary syndrome (shortness of breath, sweating, nausea)
    • Other cardiac symptoms (palpitations, peripheral oedema, paroxysmal nocturnal dyspnoea, orthopnoea)
    • Abdominal (heartburn, burping, previous history of gastroesophageal reflux)
    • Psychosomatic (anxiety, history of panic attacks)
    • Constitutional symptoms (fever, coryza)


Past Medical History

  • Vascular disease in any organ
    • Cardiac
      • Angina; previous mycardial infarction; previous angioplasty or coronary artery bypass graft surgery (CABG); stents (how many, bare metal or drug-eluting)
    • Peripheral
      • Claudication, previous peripheral vascular disease
    • Neurological
      • Previous stroke, transient ischemic attack
  • Risk factors for cardiovascular disease
    • Hypertension
    • Hypercholesterolemia
    • Diabetes
    • Smoking
    • Family history (heart attack under 60 years old, familial hypercholesterolemia)
  • Risk factors for DVT/PE
    • Recent surgery (under three months), malignancy, immobility
    • Inherited coagulopathy (e.g. protein C or S deficiency)
    • Relevant medications (e.g. oral contraceptive pill / hormone replacement therapy)
  • Risk factors for pneumothorax
    • Tall, thin men in particular
    • Known connection tissue disease (e.g. Marfans)
    • Smoking history


Drug History

  • Full drug history including recreational and over-the-counter (OTC) medications. In particular:
  • Cardiac medications
    • Beta-blockers, diuretics, antiplatelet agents, GTN spray
  • Gastric irritants
    • Non steroidal anti inflammatories (NSAIDs), steroids, bisphosphonates
  • Procoagulant medications
    • Oral contraceptive pill, hormone replacement therapy (HRT)
  • Recreational drug use
    • Cocaine (common cause of coronary artery spasm in young people)


Social history

  • Smoking history (pack years)
  • Alcohol intake (units per week)
  • Lifestyle / exercise


Click here for differential diagnosis of chest pain

Perfect revision for medical students, finals, OSCEs and MRCP PACES

Click here to learn how to take a shortness of breath history