Could you provide a sample cardiovascular OSCE history of present illness questionnaire that includes patient age, sex, presenting complaint, and systematically addresses onset, location, radiation, character, severity, timing, aggravating and relieving factors, associated symptoms, past cardiac history, risk factors, medications, allergies, family history, and social history?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: September 12, 2026 • View editorial policy

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question

Cardiovascular OSCE History of Present Illness Questionnaire

A comprehensive cardiovascular HPI questionnaire should systematically capture chest pain characteristics using the OPQRST framework (Onset, Provocation/Palliation, Quality, Radiation, Severity, Timing), followed by structured assessment of cardiac risk factors, past cardiac history, medications, and social determinants. 1, 2

Patient Demographics

  • Age: _____
  • Sex: _____
  • Date/Time of presentation: _____

Chief Complaint

Presenting symptom: (e.g., chest pain, dyspnea, palpitations, syncope)

History of Present Illness - Pain Characteristics

Onset & Duration

  • When did symptoms begin? (exact time/date)
  • Mode of onset: Gradual (builds over minutes) vs. Sudden/hyperacute
  • Duration of current episode: Seconds / Minutes / Hours / Days
  • Pattern: First episode / Recurrent / Worsening over time

Location

  • Primary site: Retrosternal / Left chest / Right chest / Epigastric / Other
  • Can you point to it with one finger? (If yes, less likely cardiac) 2

Radiation

  • Does pain spread elsewhere?
    • Neck / Jaw
    • Left shoulder/arm (LR 2.3-4.7 for ACS) 3
    • Right shoulder/arm
    • Both arms
    • Back (upper/lower - consider aortic dissection)
    • Epigastrium
    • Below umbilicus or hip (unlikely cardiac) 2

Quality/Character

  • Describe the sensation:
    • Pressure / Tightness / Heaviness / Squeezing / Crushing / Burning (typical anginal) 1, 4, 2
    • Sharp / Stabbing (LR 0.2-0.3 against ACS) 3
    • Ripping/tearing ("worst pain of my life" - consider dissection) 2, 5

Severity

  • Rate pain 0-10: _____
  • Intensity at onset: Maximal immediately vs. gradual buildup

Timing/Temporal Pattern

  • Frequency: Constant / Intermittent / Episodic
  • Duration of episodes: <5 minutes (typical angina) / >20 minutes (ACS concern) / Fleeting seconds (unlikely cardiac) 2
  • Time of day pattern: At rest / During sleep / Morning predominance

Provocative & Palliative Factors

Aggravating Factors

  • Physical exertion (walking, stairs, specific activity level in METs) 6
  • Emotional stress
  • Cold exposure
  • Large meals
  • Lying supine (consider pericarditis if worsens)
  • Inspiration/coughing (pleuritic - LR 0.2 against ACS) 3
  • Position changes (musculoskeletal if reproducible)
  • Palpation of chest wall (LR 0.2-0.3 against ACS) 3

Relieving Factors

  • Rest (typical angina relieves in <5 minutes) 4
  • Nitroglycerin (note: not diagnostic - can relieve esophageal spasm) 2
  • Position changes
  • Antacids
  • Nothing relieves it

Associated Symptoms

Cardiac-Related

  • Dyspnea (at rest / on exertion)
  • Palpitations (regular / irregular / rate)
  • Diaphoresis (profuse sweating)
  • Nausea/vomiting
  • Lightheadedness/presyncope
  • Syncope (timing, duration, prodrome)
  • Fatigue/weakness
  • Polyuria (atrial natriuretic peptide release with AF) 7

Red Flag Symptoms

  • Altered mental status (cardiogenic shock concern) 1
  • Cold extremities (reduced cardiac output) 1
  • Orthopnea/PND (heart failure)
  • Peripheral edema

Atypical Presentations (Women, Elderly, Diabetics)

  • Isolated epigastric discomfort/indigestion 1, 8
  • Isolated jaw/neck pain
  • Isolated arm pain
  • Generalized weakness
  • Confusion 8

Past Cardiac History

Prior Diagnoses

  • Coronary artery disease: Yes / No / Unknown
  • Prior myocardial infarction: (date, location, treatment)
  • Prior PCI/stenting: (date, vessels)
  • Prior CABG: (date, number of grafts)
  • Angina: Stable / Unstable / Variant
  • Heart failure: (NYHA class, EF if known)
  • Valvular disease: (specify valve, severity)
  • Arrhythmias: AF / VT / Other (specify)
  • Cardiomyopathy: Dilated / Hypertrophic / Other
  • Congenital heart disease
  • Pericarditis/myocarditis

Prior Cardiac Testing

  • Stress test: (date, result)
  • Echocardiogram: (date, key findings)
  • Cardiac catheterization: (date, findings)
  • CT coronary angiography

Cardiovascular Risk Factors 9

Hypertension

  • Diagnosed hypertension: Yes / No / Unknown
  • Current BP: / mmHg
  • Treatment: Medication / Diet / Exercise / None
  • Controlled: Yes / No

Dyslipidemia

  • Diagnosed: Yes / No / Unknown
  • Most recent lipids:
    • Total cholesterol: _____ mg/dL (>200 abnormal)
    • LDL: _____ mg/dL (≥130 abnormal)
    • HDL: _____ mg/dL (<40 men, <50 women abnormal)
  • On lipid-lowering therapy: Yes / No

Diabetes Mellitus

  • Type: Type 1 / Type 2 / None / Unknown
  • Duration: _____
  • Treatment: Insulin / Oral agents / Diet / None
  • Most recent HbA1c or fasting glucose: _____

Tobacco Use 9

  • Current smoker: (within 1 month)
  • Former smoker: (quit >3 months ago, pack-years: _____)
  • Never smoker
  • Other tobacco: Cigars / Chewing tobacco / Vaping

Family History

  • First-degree relatives with premature CAD (<55 years men, <65 years women): 9
    • MI / Angina / CABG / PCI / Sudden cardiac death
    • Specify: Relationship _____ Age at event _____

Other Risk Factors

  • Chronic kidney disease: Stage _____ (GFR: _____) 9
  • Peripheral arterial disease
  • Prior stroke/TIA
  • Obesity: BMI _____ kg/m²
  • Sedentary lifestyle (activity level in METs) 9
  • Obstructive sleep apnea
  • Chronic inflammatory conditions

Medications

Current Cardiac Medications

  • Antiplatelet agents: Aspirin / Clopidogrel / Other
  • Anticoagulants: Warfarin / DOAC (specify)
  • Beta-blockers: (name, dose)
  • ACE inhibitors/ARBs: (name, dose)
  • Statins: (name, dose)
  • Nitrates: (short-acting / long-acting)
  • Calcium channel blockers
  • Diuretics
  • Antiarrhythmics

Other Medications

  • Diabetes medications
  • Antihypertensives
  • Recent medication changes

Recent Medication Use

  • Aspirin in past 7 days: Yes / No (TIMI risk factor) 6
  • Nitroglycerin use for this episode: Response _____

Allergies

  • Drug allergies: (specify reaction)
  • Contrast allergy

Social History

Substance Use

  • Alcohol: Drinks/week _____ Pattern _____
  • Illicit drugs:
    • Cocaine (sympathomimetic, increases O₂ demand) 4
    • Methamphetamine
    • Other stimulants

Functional Status

  • Baseline activity level: Sedentary / Light / Moderate / Vigorous
  • Recent change in exercise tolerance: Yes / No
  • Able to climb stairs: Yes / No (how many flights)
  • Can perform ADLs independently: Yes / No

Occupational/Environmental

  • Occupation: (physical demands)
  • Recent stressors

Review of Systems (Cardiac-Focused)

Signs of Heart Failure

  • Orthopnea (number of pillows)
  • Paroxysmal nocturnal dyspnea
  • Peripheral edema (location, pitting)
  • Weight gain (amount, timeframe)
  • Decreased urine output

Signs of Reduced Cardiac Output 1

  • Tachycardia
  • Hypotension
  • Cool extremities
  • Altered mental status

Other Vascular Symptoms

  • Claudication
  • Abdominal pain (mesenteric ischemia)
  • Neurologic symptoms (stroke/TIA)

Clinical Pitfalls to Avoid

Common diagnostic errors: 10, 5

  • Missing aortic dissection by not asking all 5 pain characteristics (character, onset, duration, radiation, severity) - asking <2 questions increases missed diagnosis 4-fold 5
  • Gender bias - female patients with cardiac symptoms are more likely to receive incorrect diagnoses even with identical presentations 10
  • Relying on nitroglycerin response as diagnostic (non-specific) 2
  • Dismissing sharp/stabbing pain entirely (atypical presentations occur, especially in women/elderly/diabetics) 1, 8
  • Failing to document negative findings (pleuritic, positional, reproducible pain helps rule out ACS) 3

Risk Stratification Context

TIMI Risk Score elements to calculate: 6

  • Age ≥65 years
  • ≥3 CAD risk factors
  • Known CAD (stenosis ≥50%)
  • ST deviation on ECG
  • ≥2 anginal events in prior 24 hours
  • Aspirin use in prior 7 days
  • Elevated cardiac biomarkers

High-risk features requiring immediate ED transfer: 4, 8

  • Prolonged rest pain (>20 minutes)
  • Hemodynamic instability
  • New heart failure signs
  • New murmur (VSD/MR)
  • Sustained ventricular arrhythmias

References

Related Questions

What is the appropriate evaluation and management for left-sided chest pain that is tender to palpation?
Given left-arm pain radiating from the shoulder, central chest discomfort occurring twice on waking, left-neck and ear pain, and heart-rate fluctuations between bradycardia (~50 bpm) and tachycardia (~160 bpm), should I seek care in the emergency department, an urgent-care clinic, or a primary-care office?
What is the appropriate evaluation and management for a 31-year-old man with six months of chest pain?
What is the appropriate workup for chest pain in primary care?
What is the differential diagnosis for a 16-year-old female presenting with multiple vesicular lesions on both the upper and lower lips?
In a 70-year-old man with sudden gynecomastia, which medication is most likely responsible?
In a 68-year-old patient presenting with weakness, visual disturbances, confusion, severe hyperglycemia, mild metabolic acidosis, weakly positive urinary acetone, and a normal anion gap, which of the following statements is false?
Which vaccine‑preventable, food‑ and water‑borne, and vector‑borne infections are common among travelers to Greece and Italy?
Which finding is not associated with primary biliary cholangitis: osteoporosis, hypercholesterolemia, bile duct stricture, or anti‑mitochondrial antibodies?
How does telmisartan reduce proteinuria?
What literature on fetal thromboembolism or perinatal stroke discusses thrombus characteristics and embolic risk?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.