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Presentation

Chest Pain

Last Updated on May 26, 2022

ACS evaluations account for 10 – 20% of chest pain in ED. Therefore, when patients present with chest pain, it must be clerked properly!

SOCRATES

S: retrosternal / localized pain / left or right sided
O: when does the pain start?
C: pressure / sharp
R: jaw / left shoulder / arms
A: relieved by nitrates within minutes?
T: how long does the pain last?
E: at rest / exercise/cold/emotion, perspiration, nausea/vomiting
S: nausea / vomiting / palpitations / diaphoresis

Notes

• Always ask whether the pain is at rest / upon exertion (especially if suspecting ACS)

Relevant History

Patient’s background

Smoking (current, or smoking cessation ≤3 mo)
Obesity (BMI >30 kg/m²)

Co-morbidities

History of MI / PCI / CABG
History of CVA / TIA
Hypertension
Diabetes mellitus
Dyslipidaemia
Peripheral vascular disease

Family history

Family Hx of premature cardiovascular disease

• Acute coronary syndrome [open]

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