- ID
- cc: Chest pain
- HPI
- Chest pain / discomfort
- onset
- duration
- precipitants
- aggravating & alleviating factors
- quality (squeezing, crushing, pressure)
- location (central chest or epigastrium)
- radiation (jaw, arms, neck, abdo, back)
- severity
- Canadian Cardiovascular Society (CCS) Angina Grading Scale
- I: Angina only during strenuous or prolonged physical activity (e.g. shoveling snow)
- II: Slight limitation, with angina only during vigorous physical physical activity (e.g. > 2 flights of stairs)
- III: Symptoms with everyday living activities; moderate limitation (e.g. walking to washroom, 1-2 flights of stairs)
- IV: Inability to perform any activity without angina or angina at rest; severe limitation
- frequency
- Associated symptoms
- Dypnea
- amount of activity (distance walking or flights of stairs before dyspnea)
- NYHA Functional Classification
- I: No symptoms and no limitation in ordinary physical activity (e.g. SOB when walking, climbing stairs, etc.)
- II: Mild symptoms (mild SOB and/or angina) and slight limitation during ordinary activity
- III: Marked limitation in activity due to symptoms, even during less than ordinary activity (e.g. walking short distances (20-100m). Comfortable only at rest
- IV: Severe limitations. Experiences symptoms even while at rest. Mostly bedbound patients
- Orthopnea
- Ddyspnea when supine
- Ask how many pillows used for sleep
- Paroxysmal nocturnal dyspnea
- Sudden, severe SOB that wakes from sleep (associated with decompensated heart failure)
- Edema
- Swelling in legs, lower back, face
- Associated with weigh gain
- Palpitations
- Racing heart, skipping a beat, or pounding
- Syncope
- Sudden but temprary loss of consciousness and postural tone
- Fatigue (non-specific)
- Risk factors
- Modifiable
- HTN
- DM
- Obesity (increase BMD, waist circumference)
- Smoking
- Dyslipidemia (elevated cholesterol, TG)
- sedentary lifestyle
- Non-modifiable
- age
- gender
- personal history of PVD / CVD
- family history (age <55 in 1st degree male relatives, <65 in 1st degree female relatives)
- Medications
- Anti-hypertensives
- Statins
- Diabetes meds
- Allergies
- Past Medical History
- Habits
- FIFE