![]() ![]() His clinical examination is largely unremarkable, with stable vital signs (blood pressure: 120/80 mmHg heart rate: 80 beats per minute oxygen saturations: 99%) and he is afebrile. AP mentions having a ‘terrible sore throat’ several days ago, but is now on the mend. He has no classical cardiac risk factors and no previous medical illness of significance. AP had a terrible night’s sleep as the pain seemed to intensify when he lay flat in bed, so he slept mostly sitting upright in a chair. His breathing feels restricted because of the pain, but he is not overtly short of breath. Serious cardiovascular conditions, including myocardial infarction, unstable angina, pulmonary embolism and heart failureĪP reports a pleuretic, sharp pain that is localised to his left thorax without any radiation. Causes of chest pains presenting in general practice, compared with emergency departments 1 Common causes of chest pain are shown in Table 1. acute changes in vital signs, with particular attention to signs of shock (ie diaphoresis, clamminess, tachycardia, decreased blood pressure)Īs with the history taking, respiratory, abdominal and localised musculoskeletal examinations are also likely to be indicated.Blood pressure should be measured in both arms and the patient assessed for presence of: Physical examination of a patient who presents with chest pain includes primarily a cardiovascular examination. The cardiovascular system is the main focus in patients who present with chest pain, but evaluation of the respiratory system, upper gastrointestinal system and focused musculoskeletal history, looking specifically for trauma in the area of pain, is also required. After elaborating on the presenting complaint, the history should focus on the presence of risk factors, such as history of cardiovascular disease, connective tissue or autoimmune diseases, renal impairment, diabetes, hypertension, dyslipidaemia, positive family history of cardiac disease and smoking history. Important elements on history are the description of the pain and its associated symptoms. History takingĬhest pain is a common presenting symptom and the initial clinical assessment is vital in differentiating and triaging the direction of care. In fact the paramedic administered NTG, per protocol according to him for the chest pain, although he did say he suspected it wasn't going to help and after the NTG, the systolic only came down into the 120s, with the diastolic continuing to remain in the low-80s.AP is a male, aged 20 years, who presents to your practice with chest pains that commenced the preceding night, now exceeding 12 hours in duration. Another BP after that was, if I recall, in the 130s over, again, a low-80 diastolic.Īt the first LP12 BP, I thought perhaps it had elevated from walking out to the ambulance, but it never came back down to what I thought I heard. Next check several minutes later was a systolic in the low 140s, diastolic remaining pretty much the same. walk out to the ambulance and the paramedic used the LP12, which obtained a BP of 149/81. These vitals were obtained by me inside the house. Complaint was chest pain, overall weakness and "feeling sick", with a fever that at one point was allegedly 105 but was 100.1 for us. Pt.'s other vitals were HR of 110-120, RR of 40-54 (double-checked), skin warm, moist, and pink, and eyes PERRL. But at around 110, I began to hear the more typical low-pitched thumping, which I heard down to 80, so I reported his BP as 110/80. This was a sound similar to what you'd hear if you tap a pen on a desk. I started to hear a high-pitched ticking or clicking in the 140s. The other day I was auscultating a BP and heard something weird. ![]()
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