What are the key components to include when taking a history of present illness for a patient with chest pain?

From the Guidelines

When taking a history of present illness for a patient with chest pain, clinicians should focus on key components that help differentiate between life-threatening causes and less urgent conditions, as outlined in the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain 1. The key components to include when taking a history of present illness for a patient with chest pain are:

• Onset: when the pain started and if it was sudden or gradual
• Provocation/Palliation: what makes the pain worse or better, including position changes, exertion, or medications like nitroglycerin
• Quality: how the patient describes the pain—sharp, dull, pressure, burning, tearing
• Radiation: whether the pain spreads to other areas like the jaw, arm, or back
• Severity: using a 1-10 scale to quantify pain intensity
• Timing: duration of episodes and if the pain is constant or intermittent
• Associated symptoms: such as shortness of breath, nausea, diaphoresis, dizziness, or palpitations
• Aggravating/Alleviating factors: specific activities or interventions affecting the pain
• Patient's own Assessment: what they think is happening These components are crucial in determining the likelihood of myocardial ischemia, as described in the evaluation of primary care patients with chronic stable angina guidelines from the American College of Physicians 1. It is essential to ascertain the characteristics of the chest pain directly from the patient for optimal interpretation, as emphasized in the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline 1. The diagnosis of ischemia may require data beyond history alone, and the source of cardiac symptoms is complex, and their expression is variable, as noted in the diagnosis of stable ischemic heart disease guideline from the American College of Physicians/American College of Cardiology Foundation/American Heart Association/American Association for Thoracic Surgery/Preventive Cardiovascular Nurses Association/Society of Thoracic Surgeons 1. A careful history is the initial step in evaluating a patient with chest pain, and it should include a detailed description of symptoms, as outlined in the diagnosis of stable ischemic heart disease guideline 1. The pattern of symptoms often provides crucial diagnostic clues, and the use of "atypical" to describe chest pain is discouraged, as stated in the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline 1. The evaluation of chest pain should focus on the early identification or exclusion of life-threatening causes, and patients with acute chest pain or chest pain equivalent symptoms should seek medical care immediately, as recommended in the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

History of Present Illness for a Patient with Chest Pain

The history of present illness for a patient with chest pain should include the following key components:

• Description of the chest pain:
  • Location
  • Quality
  • Severity
  • Duration
  • Triggers
  • Relieving factors
• Associated symptoms:
  • Shortness of breath
  • Dizziness
  • Nausea
  • Vomiting
  • Diaphoresis
• Timing of symptoms:
  • Onset
  • Frequency
  • Duration
• Risk factors for cardiac disease:
  • Hypertension
  • Hyperlipidemia
  • Diabetes
  • Family history of cardiac disease
  • Smoking history
• Previous cardiac history:
  • Previous myocardial infarction
  • Previous coronary artery bypass grafting
  • Previous percutaneous coronary intervention

Assessment and Management

As noted in the study 2, the assessment and management of chest pain in primary care should focus on acute coronary syndrome, with key differentials and essential primary care investigations and management outlined. The study 3 also highlights the importance of thrombolytic drug treatment and the use of glyceryl trinitrate and beta blocking drugs in the management of acute coronary syndromes.

Importance of Comprehensive History

A comprehensive history is crucial in evaluating and diagnosing chest pain, as noted in the study 4. The study 5 also emphasizes the importance of a thorough history and physical examination, as well as the use of diagnostic tests such as electrocardiogram and chest radiograph.

Symptom Description

The study 6 highlights the importance of symptom description in patients with chest pain, with patients presenting a wide range of symptoms and situational information. The study notes that patients with chest pain caused by a high-risk condition present a variety of symptoms, including pain and affected breathing, and that risk stratification on the basis of symptoms alone can be difficult.

Template for History of Present Illness

A template for the history of present illness for a patient with chest pain could be: "The patient is a [age]-year-old [sex] who presents with [duration] of chest pain, described as [quality] and [severity], located in the [location] and radiating to the [radiation]. The pain is [triggered by] and [relieved by]. The patient also reports [associated symptoms]. The patient has a history of [risk factors for cardiac disease] and [previous cardiac history]."