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More chest pain – what to do?

Patient ideas:    It just came on for no reason
Concerns: Could it be something serious?
Expectations:  Reassurance. Don’t want to come in if it’s nothing to worry about.

Chief Complaint
Martin A is a 48 year old male. The “Chest Pain” screening questionnaire was administered.
The following are his responses.
History of Present Illness
#1. “Chest Pain”
He reported: Chest pain 1 week.
He reported: Chest pain comes and goes and unsure about the first onset. Same
chest pain.
He denied: Chest pain started after activity or exercise. Pains or tightness across
the chest now.
He reported: Chest pain mild.
He reported: Mild burning chest pain and sharp chest pain. Chest pain mild aching.
He denied: Chest pain electric shock-like, sudden, sharp, tearing, and heavy, deep,
crushing. Squeezing heavy chest pressure.
He reported: Chest pain started in the lower chest near rib cage, 1 to 2 inches
inside, left side of chest, and always in the same place.
He denied: Chest pain spreads to another area.
He reported: Chest pain sometimes associated with leaning forward.
He reported: Chest pain unrelated to eating.
Modifying Factors
He reported: Chest pain unrelieved by rest. Deep breathing sometimes worsens
chest pain. Chest pain sometimes worsened by cough. Chest pain sometimes
worsened by sneezing or straining. Chest pain sometimes made worse by moving
arms, reaching, or twisting body.
He denied: Chest pain worse on lying down.
Associated Signs and Symptoms
He denied: Chest pain associated with claudication. Chest pain causes sweating,
causes hands, feet, and lips feel numb, and caused loss of consciousness. Heart
beat misses or flutters with the chest pain. Shortness of breath with chest pain.
Nauseated along with the chest pain. Flushed with the chest pain. Feel dizzy or
weak with the chest pain.
Past, Family, and Social History
Past Medical History
He denied: Heart disease.
Accidents and Injuries
He denied: Slight injury, insect bite or sting, or surgery in last 3 months.
Family History
He denied: Premature heart disease.
Social History
Activities for Daily Living
He reported: Chest pain does not interfere with activities of daily living.
Substance Use
Tobacco Use
He denied: Smoking cigarettes.
History of: Alcohol use. Consuming more than 5 drinks of alcohol in 1 day
within the last 3 months.
He denied: Feeling should cut down on drinking. People annoyed you by
criticising drinking. Felt bad or guilty about own drinking. Had an ‘eye-opener’
drink first thing in the morning.
Drug Usage
He reported: Never used illegal drugs.
History of: Consumes more than 3 caffeinated drinks per day.
Medication History
Ongoing Medications
He denied: Medication for chest pain.
Review of Systems
He denied: Night sweats. Fever in the last week. Lost weight in the last 6 months
without dieting. He reported: Health status very good.
He denied: Cough. Recent respiratory symptoms improved then worsened.
He denied: Chest pain associated with leg symptoms.
Anxiety Disorders
He denied: Felt nervous, anxious, or under stress.
Patient viewed NHS information.  Comments:
From the information given, it looks like this is not serious but good to know anyway.

GPs, what would you do first?

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