From the Guidelines
A History of Present Illness (HPI) should be written as a chronological narrative that describes the patient's current medical problem from its onset until the present moment. This is crucial in driving the remainder of the examination, assessment, and decision-making process, as emphasized in the 2017 AHA/ACC report on key data elements and definitions for ambulatory electronic health records in pediatric and congenital cardiology 1. When writing an HPI, it is essential to begin with the patient's age, gender, and relevant medical history.
- The HPI should then detail when symptoms started, their character, severity, location, duration, aggravating and alleviating factors, and progression over time.
- Include treatments the patient has already tried and their effectiveness, as this information is vital in understanding the patient's response to previous interventions.
- Document associated symptoms, relevant negatives, and how the condition affects the patient's daily functioning, using the patient's own words when appropriate to capture their experience accurately.
- The HPI should be detailed enough to understand the clinical situation but concise enough to highlight the most important elements, as noted in the report by the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards 1.
By following this format, clinicians can establish a clear timeline of the illness, identify patterns, and develop appropriate differential diagnoses, ultimately guiding the subsequent physical examination and diagnostic workup.
From the Research
History of Present Illness (HPI)
The History of Present Illness (HPI) is a crucial component of a patient's medical history, particularly when presenting with chest pain.
- It involves a detailed description of the patient's symptoms, including the onset, duration, severity, and characteristics of the chest pain 2, 3, 4, 5.
- The HPI should also include information about any associated symptoms, such as shortness of breath, dizziness, or nausea 3, 4.
- Patients with chest pain may use different terms to describe their discomfort, and healthcare providers should be aware of these terms to accurately identify the underlying cause of the symptom 5.
- The HPI can help healthcare providers distinguish between typical and atypical chest pain, which is essential for determining the appropriate diagnostic work-up and management plan 5.
Components of HPI for Chest Pain
The HPI for chest pain should include the following components:
- Location and radiation of the pain
- Quality and severity of the pain
- Duration and onset of the pain
- Associated symptoms, such as shortness of breath or dizziness
- Factors that exacerbate or relieve the pain
- Patient's medical history, including any previous cardiac or pulmonary conditions 2, 3, 4.
Importance of Accurate HPI
An accurate HPI is essential for diagnosing the underlying cause of chest pain and developing an effective management plan.
- It can help healthcare providers identify life-threatening conditions, such as acute coronary syndrome or pulmonary embolism, and initiate prompt treatment 2, 3, 4.
- The HPI can also help healthcare providers distinguish between cardiac and non-cardiac causes of chest pain, which is critical for determining the appropriate diagnostic work-up and management plan 5.
- Additionally, the HPI can help healthcare providers identify patients with anxiety disorders, which are commonly associated with chest pain and can be effectively treated with appropriate therapy 6.